BMJ Open (Mar 2023)
Biomarker-guided intervention to prevent acute kidney injury after major surgery (BigpAK-2 trial): study protocol for an international, prospective, randomised controlled multicentre trial
- ,
- Joachim Gerss,
- Javier Ripollés-Melchor,
- Emmanuel Futier,
- Melanie Meersch,
- Carola Wempe,
- Detlef Kindgen-Milles,
- Alexander Zarbock,
- Markus W Hollmann,
- Sigismond Lasocki,
- Thomas Rimmele,
- Tim Rahmel,
- Michael Adamzik,
- Hartmuth Nowak,
- Ingeborg Welters,
- Brian Johnston,
- Ane Abad-motos,
- Alfredo Abad-gurumeta,
- Marc Moritz Berger,
- Davide Ricci,
- Maurizio Cecconi,
- Gudrun Kunst,
- Christian Stoppe,
- Christian Putensen,
- Marlies Ostermann,
- Sascha Ott,
- Brijesh Patel,
- Gabriele Baldini,
- Antoine Lamblin,
- Karen Williams,
- Elena Mancini,
- Christian Arndt,
- Hinnerk Wulf,
- Marc Irqsusi,
- Wim Vandenberghe,
- John Kellum,
- Raphael Weiss,
- Jackie Donovan,
- Lui G Forni,
- Giacomo Monti,
- Céline Monard,
- Markus A Weigand,
- Thorsten Brenner,
- Ulrich Jaschinski,
- Carlos Lopez,
- Maxime Leger,
- Emmanuel Rineau,
- Philipp Simon,
- María Gómez-Rojo,
- Lars Bergmann,
- Alicia Waite,
- Savino Spadaro,
- Alexander Wolf,
- Andrew Spence,
- Simon Dubler,
- Alexander PJ Vlaar,
- Patrick Schober,
- Ben C Creagh-Brown,
- Nandor Marczin,
- Emilio Maseda,
- Christian Strauss,
- Stefano Romagnoli,
- Christian Nusshag,
- Ulrich Gobel,
- Ángel Candela-Toha,
- Jon Silversides,
- Nuttha Lumlertgul,
- Khaschayar Saadat-Gilani,
- Vincent Legros,
- Timo Brandenburger,
- Thomas Dimski,
- Laura Huthmann,
- Claude Pelletier,
- Manon Schleß,
- Peter Rosenberger,
- Helene Häberle,
- Jan Gerrit Haaker,
- Matthias Gründel,
- Lucia Cattin,
- Laura Villarino Villa,
- Juan Victor Lorente,
- Christine Martin,
- Jan Larmann,
- Wolfgang Bauer,
- Giovanni Borghi,
- Benjamin O’Brien,
- Thilo von Groote,
- Antoine Guillaume Schneider,
- Silvia De Rosa,
- Diego Parise,
- Alice Bernard,
- Paula Fernández-Valdes-Bango,
- Irene Romero Bhathal,
- A Suarez-de-la-Rica,
- Gianluca Villa,
- Raquel García-Álvarez,
- Antonio Siniscalchi,
- Richard Ellerkmann,
- Florian Espeter,
- Christian Porschen,
- Mahan Sadjadi,
- Michael Storck,
- Tobias Brix,
- Dana Meschede,
- Wida Amini,
- Carina Stenger,
- Julius Freytag,
- Jens Brands,
- Matthias Unterberg,
- Britta Marko,
- Fabian Dusse,
- Wolfgang A Wetsch,
- Sandra E Stoll,
- Hendrik Drinhaus,
- Bernd W Böttiger,
- Onnen Mörer,
- Lars-Olav Harnisch,
- Roswitha Lubjuhn,
- Daniel Heise,
- Christian Bode,
- Andrea Sauer,
- Konrad Peukert,
- Lennart Wild,
- Philippe Kruse,
- Jan Menzenbach,
- Valbona Mirakaj,
- Sabine Hermann,
- Stefanie Decker,
- Mona Jung-König,
- Tobias Hölle,
- Sarah Dehne,
- Jörg Reutershan,
- Thomas Prüfer,
- Stefan Pielmeier,
- Indra Wimmelmeier,
- Michaela Scholz,
- Andrea Paris,
- Isabel Christina Gallego Zapata,
- Holger Pohl,
- Nirmeen Fayed,
- Kai Dielmann,
- Evelyn Martin,
- Tilo Koch,
- Alexander Mück,
- Philipp Deetjen,
- Ngoc Bich Mehlmann,
- Peter M Spieth,
- Andreas Güldner,
- Axel Rand,
- Maximillian Ragaller,
- Martin Mirus,
- Rebecca Bockholt,
- Marc Herzog,
- Maren Kleine-Brüggeney,
- Ant Isabelle Cristiani,
- Marion Ohl,
- Monica Vieira Da Silva,
- Gilda Filipe de Castro Reblo,
- Matthias Hilty,
- Katharina Spanaus,
- Benedetta Mura,
- Eleonora Terreni,
- Francesco Magiotti,
- Lorenzo Turi,
- Cristiana Laici,
- Chiara Capozzi,
- Andrea Castelli,
- Massimiliano Greco,
- Antonio Messina,
- Gianluca Castellani,
- Romina Aceto,
- Vinicio Danzi,
- Alessandro Rigobello,
- Massimo De Cal,
- Monica Zanella,
- Gaetano Scaramuzzo,
- Riccardo La Rosa,
- Paolo Priani,
- Alberto Volta Carlo,
- Stefano Turi,
- Martina Baiardo Redaelli,
- Marilena Marmiere,
- Kittisak Weerapolchai,
- Shelley Lorah,
- Fabiola D’Amato,
- Aneta Bociek,
- Rosario Lim,
- Benjie Cendreda,
- Reynaldo Dela Cuesta,
- Eirini Kosifidou,
- Zoka Milan,
- Juliana Fernanda,
- Emma Clarey,
- Daveena Meeks,
- Nicholas J Lees,
- Marco Scaramuzzi,
- Orinta Kviatkovske,
- Adam Glass,
- Christine Turley,
- Charlotte Quinn,
- Syeda Haider,
- Adam Rossiter,
- Syed Nasser,
- Ned Gilbert-Kawai,
- Tatjana Besse-Hammer,
- Eric Hoste,
- Hannah Schaubroeck,
- Jan De Waele,
- Jenni Breel,
- Eline de Klerk,
- Harm-Jan de Grooth,
- Lothar Schwarte,
- Alexander Loer,
- Alicia Ruiz-Escobar,
- Diana Fernández-García,
- Nerea Gómez-Pérez,
- Pascual Crespo-Aliseda,
- Cristina Cerro-Zaballos,
- Cristina Fernández-Martín,
- Eduardo Martín-Montero,
- Alejandro Suarez de la Rica,
- Héctor Berges Gutiérrez,
- Maria del Pino Heredia Pérez,
- Maria de los Reyes Bellido Fernández,
- Liena Izquierdo López,
- Javier Valiente Lourtau,
- Ma Angeles Ferre Colomer,
- Ma Azucena Pajares Moncho,
- Maria Jesús Montero Hernández,
- Esther Pérez Sancho,
- Silvia Polo Matínez,
- Pedro Rivera Soria,
- Maider Puyada Jáuregui,
- Hugo Rivera Ramos,
- Marta Antelo Adrán,
- Ramón Adalia Bartolomé,
- Patricia Galán Menéndez,
- Laura Llinares Espin,
- Yuri Santiago Loaiza Aldean,
- Víctor MoralesAriza,
- Rosalía Navarro-Perez,
- Luis Santé-Serna,
- Pedro de la Calle-Elguezabal,
- Rubén Sánchez-Martín,
- Inés De Soto,
- Pau Vallhonrat Alcántara,
- Laura Perelló Cerdà,
- Gal·la Rouras Hurtado,
- Paula Rodriguez Nieto,
- John Narros Sicluna,
- Angel Molero Molinero,
- Juan Pablo Nocete,
- Elena Murcia Sánchez,
- Stanislas Abrard,
- Marie-Luce Parrouffe,
- Frank Bidar,
- Lucie Aupetitgendre,
- Ugo Schiff,
- Bertille Paquette,
- Gaëlle Sellier,
- Nathalie Borgnetta,
- Benjamin Brochet,
- Thierry Floch,
- Julien Coffinet,
- Marion Leclercq-Rouget
Affiliations
- Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Munster, Nordrhein-Westfalen, Germany
- Javier Ripollés-Melchor
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Madrid, Spain
- Emmanuel Futier
- Melanie Meersch
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
- Carola Wempe
- Detlef Kindgen-Milles
- Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
- Markus W Hollmann
- Sigismond Lasocki
- Thomas Rimmele
- Tim Rahmel
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
- Michael Adamzik
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
- Hartmuth Nowak
- Ingeborg Welters
- Brian Johnston
- 1 Department of Critical Care, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Ane Abad-motos
- Alfredo Abad-gurumeta
- Marc Moritz Berger
- Davide Ricci
- Maurizio Cecconi
- Gudrun Kunst
- Christian Stoppe
- Christian Putensen
- Department of Anesthesiology and Surgical Intensive Care Medicine, Division of Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
- Marlies Ostermann
- Department of Critical Care, King`s College London, Guy`s and St Thomas` Hospitals NHS Trust, London, London, UK
- Sascha Ott
- Brijesh Patel
- Gabriele Baldini
- Antoine Lamblin
- Karen Williams
- Elena Mancini
- Christian Arndt
- Anesthesiology and Intensive Care Medicine, Philipps-Universitat Marburg Fachbereich Medizin, Marburg, Germany
- Hinnerk Wulf
- Anesthesiology and Intensive Care Medicine, Philipps-Universitat Marburg Fachbereich Medizin, Marburg, Germany
- Marc Irqsusi
- Wim Vandenberghe
- Department of Intensive Care Medicine, Universiteit Gent, Gent, Belgium
- John Kellum
- Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Raphael Weiss
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
- Jackie Donovan
- Lui G Forni
- Giacomo Monti
- Céline Monard
- Service d`Anesthésie-Réanimation, Hôpital Edouard Herriot, Lyon, Rhône-Alpes, France
- Markus A Weigand
- Thorsten Brenner
- Ulrich Jaschinski
- Carlos Lopez
- Maxime Leger
- Emmanuel Rineau
- Philipp Simon
- María Gómez-Rojo
- Lars Bergmann
- Alicia Waite
- Savino Spadaro
- Department of Translational Medicine and for Romagna, St. Anne`s Archbishop Hospital, University of Ferrara, Ferrara, Emilia-Romagna, Italy
- Alexander Wolf
- Andrew Spence
- Simon Dubler
- Alexander PJ Vlaar
- Patrick Schober
- Ben C Creagh-Brown
- Nandor Marczin
- Emilio Maseda
- Christian Strauss
- Stefano Romagnoli
- Department of Health Sciences, Section of Anesthesiology, Intensive Care and Pain Medicine, University of Florence; Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Christian Nusshag
- Ulrich Gobel
- Department of Anesthesiology and Intensive Care, St Franziskus-Hospital Münster GmbH, Munster, Nordrhein-Westfalen, Germany
- Ángel Candela-Toha
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
- Jon Silversides
- Nuttha Lumlertgul
- Department of Critical Care & Nephrology, Guy’s and St Thomas Hospital, London, UK
- Khaschayar Saadat-Gilani
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
- Vincent Legros
- Timo Brandenburger
- Anesthesiology and Critical Care Medicine, Heinrich Heine University Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
- Thomas Dimski
- Laura Huthmann
- Claude Pelletier
- Manon Schleß
- Peter Rosenberger
- Helene Häberle
- Jan Gerrit Haaker
- Department of Anesthesiology and Intensive Care, St Franziskus-Hospital Münster GmbH, Munster, Nordrhein-Westfalen, Germany
- Matthias Gründel
- Lucia Cattin
- Department of Anesthesiology and Intensive Care Medicine, San Bortolo Hospital of Vicenza, Vicenza, Veneto, Italy
- Laura Villarino Villa
- Juan Victor Lorente
- Christine Martin
- Department of Neurology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Jan Larmann
- Department of Anaesthesia, Heidelberg University Hospital, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
- Wolfgang Bauer
- Giovanni Borghi
- Benjamin O’Brien
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- Thilo von Groote
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
- Antoine Guillaume Schneider
- Adult Intensive Care Unit, University Hospital of Lausanne, Lausanne, Switzerland
- Silvia De Rosa
- Department of Anesthesiology and Intensive Care Medicine, San Bortolo Hospital of Vicenza, Vicenza, Veneto, Italy
- Diego Parise
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
- Alice Bernard
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, University of Tübingen, Tubingen, Baden-Württemberg, Germany
- Paula Fernández-Valdes-Bango
- Departamento de Anestesia, Hospital Universitario Infanta Leonor, Madrid, Spain
- Irene Romero Bhathal
- Department of Anaesthesiology and Intensive Care Medicine, Consorci Parc de Salut MAR de Barcelona, Barcelona, Catalunya, Spain
- A Suarez-de-la-Rica
- Department of Anesthesiology and Critical Care, Hospital Universitario Marques de Valdecilla, Santander, Spain
- Gianluca Villa
- Department of Health Sciences, Section of Anesthesiology, Intensive Care and Pain Medicine, University of Florence; Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Raquel García-Álvarez
- Department of Anesthesia and Intensive Care, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
- Antonio Siniscalchi
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Emilia-Romagna, Italy
- Richard Ellerkmann
- Department of Anesthesiology, Intensive Care, Pain Medicine and Palliative Care Medicine, Hospital Dortmund, Dortmund, Germany
- Florian Espeter
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
- Christian Porschen
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
- Mahan Sadjadi
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
- Michael Storck
- Tobias Brix
- Dana Meschede
- Wida Amini
- Carina Stenger
- Julius Freytag
- Jens Brands
- Matthias Unterberg
- Britta Marko
- Fabian Dusse
- Wolfgang A Wetsch
- Sandra E Stoll
- Hendrik Drinhaus
- Bernd W Böttiger
- Onnen Mörer
- Lars-Olav Harnisch
- Roswitha Lubjuhn
- Daniel Heise
- Christian Bode
- Andrea Sauer
- Konrad Peukert
- Lennart Wild
- Philippe Kruse
- Jan Menzenbach
- Valbona Mirakaj
- Sabine Hermann
- Stefanie Decker
- Mona Jung-König
- Tobias Hölle
- Sarah Dehne
- Jörg Reutershan
- Thomas Prüfer
- Stefan Pielmeier
- Indra Wimmelmeier
- Michaela Scholz
- Andrea Paris
- Isabel Christina Gallego Zapata
- Holger Pohl
- Nirmeen Fayed
- Kai Dielmann
- Evelyn Martin
- Tilo Koch
- Alexander Mück
- Philipp Deetjen
- Ngoc Bich Mehlmann
- Peter M Spieth
- Andreas Güldner
- Axel Rand
- Maximillian Ragaller
- Martin Mirus
- Rebecca Bockholt
- Marc Herzog
- Maren Kleine-Brüggeney
- Ant Isabelle Cristiani
- Marion Ohl
- Monica Vieira Da Silva
- Gilda Filipe de Castro Reblo
- Matthias Hilty
- Katharina Spanaus
- Benedetta Mura
- Eleonora Terreni
- Francesco Magiotti
- Lorenzo Turi
- Cristiana Laici
- Chiara Capozzi
- Andrea Castelli
- Massimiliano Greco
- Antonio Messina
- Gianluca Castellani
- Romina Aceto
- Vinicio Danzi
- Alessandro Rigobello
- Massimo De Cal
- Monica Zanella
- Gaetano Scaramuzzo
- Riccardo La Rosa
- Paolo Priani
- Alberto Volta Carlo
- Stefano Turi
- Martina Baiardo Redaelli
- Marilena Marmiere
- Kittisak Weerapolchai
- Shelley Lorah
- Fabiola D’Amato
- Aneta Bociek
- Rosario Lim
- Benjie Cendreda
- Reynaldo Dela Cuesta
- Eirini Kosifidou
- Zoka Milan
- Juliana Fernanda
- Emma Clarey
- Daveena Meeks
- Nicholas J Lees
- Marco Scaramuzzi
- Orinta Kviatkovske
- Adam Glass
- Christine Turley
- Charlotte Quinn
- Syeda Haider
- Adam Rossiter
- Syed Nasser
- Ned Gilbert-Kawai
- Tatjana Besse-Hammer
- Eric Hoste
- Hannah Schaubroeck
- Jan De Waele
- Jenni Breel
- Eline de Klerk
- Harm-Jan de Grooth
- Lothar Schwarte
- Alexander Loer
- Alicia Ruiz-Escobar
- Diana Fernández-García
- Nerea Gómez-Pérez
- Pascual Crespo-Aliseda
- Cristina Cerro-Zaballos
- Cristina Fernández-Martín
- Eduardo Martín-Montero
- Alejandro Suarez de la Rica
- Héctor Berges Gutiérrez
- Maria del Pino Heredia Pérez
- Maria de los Reyes Bellido Fernández
- Liena Izquierdo López
- Javier Valiente Lourtau
- Ma Angeles Ferre Colomer
- Ma Azucena Pajares Moncho
- Maria Jesús Montero Hernández
- Esther Pérez Sancho
- Silvia Polo Matínez
- Pedro Rivera Soria
- Maider Puyada Jáuregui
- Hugo Rivera Ramos
- Marta Antelo Adrán
- Ramón Adalia Bartolomé
- Patricia Galán Menéndez
- Laura Llinares Espin
- Yuri Santiago Loaiza Aldean
- Víctor MoralesAriza
- Rosalía Navarro-Perez
- Luis Santé-Serna
- Pedro de la Calle-Elguezabal
- Rubén Sánchez-Martín
- Inés De Soto
- Pau Vallhonrat Alcántara
- Laura Perelló Cerdà
- Gal·la Rouras Hurtado
- Paula Rodriguez Nieto
- John Narros Sicluna
- Angel Molero Molinero
- Juan Pablo Nocete
- Elena Murcia Sánchez
- Stanislas Abrard
- Marie-Luce Parrouffe
- Frank Bidar
- Lucie Aupetitgendre
- Ugo Schiff
- Bertille Paquette
- Gaëlle Sellier
- Nathalie Borgnetta
- Benjamin Brochet
- Thierry Floch
- Julien Coffinet
- Marion Leclercq-Rouget
- DOI
- https://doi.org/10.1136/bmjopen-2022-070240
- Journal volume & issue
-
Vol. 13,
no. 3
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.