Biomarker-guided intervention to prevent acute kidney injury after major surgery (BigpAK-2 trial): Study protocol for an international, prospective, randomised controlled multicentre trial

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Thilo Von Groote - , University of Münster (Author)
  • Melanie Meersch - , University of Münster (Author)
  • Stefano Romagnoli - , Careggi University Hospital (Author)
  • Marlies Ostermann - , Guy's and St Thomas' NHS Foundation Trust (Author)
  • Javier Ripollés-Melchor - , Complutense University (Author)
  • Antoine Guillaume Schneider - , University of Lausanne (Author)
  • Wim Vandenberghe - , Ghent University (Author)
  • Céline Monard - , Hôpital Édouard Herriot (Author)
  • Silvia De Rosa - , Azienda Sanitaria Ulss 6 Vicenza, University of Trento (Author)
  • Lucia Cattin - , Azienda Sanitaria Ulss 6 Vicenza (Author)
  • Tim Rahmel - , Ruhr University Bochum (Author)
  • Michael Adamzik - , Ruhr University Bochum (Author)
  • Diego Parise - , Hospital Ramon y Cajal (Author)
  • Angel Candela-Toha - , Hospital Ramon y Cajal (Author)
  • Jan Gerrit Haaker - , St. Franziskus-Hospital Münster (Author)
  • Ulrich Göbel - , St. Franziskus-Hospital Münster (Author)
  • Alice Bernard - , University Hospital Tübingen (Author)
  • Nuttha Lumlertgul - , Guy's and St Thomas' NHS Foundation Trust, Chulalongkorn University (Author)
  • Paula Fernández-Valdes-Bango - , Complutense University (Author)
  • Irene Romero Bhathal - , Consorci Parc de Salut MAR de Barcelona (Author)
  • A. Suarez-De-La-Rica - , Hospital Universitario Marques de Valdecilla, Universidad Autónoma de Madrid (Author)
  • Jan Larmann - , Heidelberg University  (Author)
  • Gianluca Villa - , Careggi University Hospital (Author)
  • Savino Spadaro - , University of Ferrara (Author)
  • Hinnerk Wulf - , University of Marburg (Author)
  • Christian Arndt - , University of Marburg (Author)
  • Christian Putensen - , University of Bonn (Author)
  • Raquel García-Álvarez - , Hospital Universitario (Author)
  • Timo Brandenburger - , Heinrich Heine University Düsseldorf (Author)
  • Antonio Siniscalchi - , University of Bologna (Author)
  • Richard Ellerkmann - , Hospital Dortmund (Author)
  • Florian Espeter - , University of Duisburg-Essen (Author)
  • Christian Porschen - , University of Münster (Author)
  • Mahan Sadjadi - , University of Münster (Author)
  • Khaschayar Saadat-Gilani - , University of Münster (Author)
  • Raphael Weiss - , University of Münster (Author)
  • Joachim Gerss - , University of Münster (Author)
  • John Kellum - , University of Pittsburgh (Author)
  • Alexander Zarbock - , University of Münster (Author)

Abstract

Introduction Previous studies demonstrated that the implementation of the Kidney Disease Improving Global Outcomes (KDIGO) guideline-based bundle, consisting of different supportive measures in patients at high risk for acute kidney injury (AKI), might reduce rate and severity of AKI after surgery. However, the effects of the care bundle in broader population of patients undergoing surgery require confirmation. Methods and analysis The BigpAK-2 trial is an international, randomised, controlled, multicentre trial. The trial aims to enrol 1302 patients undergoing major surgery who are subsequently admitted to the intensive care or high dependency unit and are at high-risk for postoperative AKI as identified by urinary biomarkers (tissue inhibitor of metalloproteinases 2∗insulin like growth factor binding protein 7 (TIMP-2)∗IGFBP7)). Eligible patients will be randomised to receive either standard of care (control) or a KDIGO-based AKI care bundle (intervention). The primary endpoint is the incidence of moderate or severe AKI (stage 2 or 3) within 72 hours after surgery, according to the KDIGO 2012 criteria. Secondary endpoints include adherence to the KDIGO care bundle, occurrence and severity of any stage of AKI, change in biomarker values during 12 hours after initial measurement of (TIMP-2)∗(IGFBP7), number of free days of mechanical ventilation and vasopressors, need for renal replacement therapy (RRT), duration of RRT, renal recovery, 30-day and 60-day mortality, intensive care unit length-of-stay and hospital length-of-stay and major adverse kidney events. An add-on study will investigate blood and urine samples from recruited patients for immunological functions and kidney damage. Ethics and dissemination The BigpAK-2 trial was approved by the Ethics Committee of the Medical Faculty of the University of Münster and subsequently by the corresponding Ethics Committee of the participating sites. A study amendment was approved subsequently. In the UK, the trial was adopted as an NIHR portfolio study. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and will guide patient care and further research. Trial registration number NCT04647396.

Details

Original languageEnglish
Article numbere070240
JournalBMJ open
Volume13
Issue number3
Publication statusPublished - 27 Mar 2023
Peer-reviewedYes

External IDs

PubMed 36972972

Keywords

ASJC Scopus subject areas

Keywords

  • Acute renal failure, Adult intensive & critical care, Chronic renal failure, INTENSIVE & CRITICAL CARE, SURGERY