BigpAK-2

Objectives

The purpose of this study is to investigate the effect of the implementation of the KDIGO bundle in patients at high risk for AKI after major surgery compared to standard of care in the same patient population. This biomarker-guided approach (individualized therapy) allows treating patients at high risk for AKI prior to functional damage of the kidneys.

Inclusion criteria

1. Patients after major surgery who need to be admitted to the ICU
2. Age > 18 years
3. [TIMP-2]*[IGFBP7] ≥ 0.3 4-18 hours after surgery
4. Inserted jugular central venous line and a urinary catheter
5. Written informed consent.
6. At least one additional risk factor for AKI:

• Age > 75 years
• Critical illness such as ongoing requirement of vasopressor support and/or mechanical ventilation postoperatively
• Pre-existing chronic kidney disease (eGFR<60ml/min)
• Intraoperative use of radio contrast agents.

Exclusion criteria

1. Pregnancy or breastfeeding
2. Pre- existing high stages of chronic kidney disease (stage 4 or 5 i.e. eGFR < 15 ml/ min)
3. Kidney transplant within the last 12 months
4. Known (Glomerulo-) Nephritis, interstitial nephritis or vasculitis
5. Anuria at inclusion time
6. Preexisting AKI
7. Renal replacement therapy (RRT) within the last 90 days
8. Indication for renal replacement at the time of inclusion
9. Participation in another intervention trial that investigates a drug/intervention that affects kidney function
10. Persons held in an institution by legal or official order
11. Persons with any kind of dependency on the investigator or employed by the responsible institution or investigator

For further information, please contact aki@anit.uni-muenster.de