Biomarker-guided Implementation of the AKI Bundle

NCT ID: NCT03244514

Last Updated: 2020-02-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

280 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-11-02

Study Completion Date

2020-01-26

Brief Summary

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There is no specific therapy for acute kidney injury. It is presumed that supportive measures improve the care and outcome of patients with acute kidney injury.

The investigators hypothesize that the implementation of a bundle of supportive measures adapted to patients undergoing cardiovascular surgery reduces the occurence of AKI.

A Randomized prospective multicenter trial is needed to investigate whether the implementation of the bundle of measures is effective to prevent AKI in high risk patients undergoing cardiac surgery. In this feasibility trial the investigators will analyze the compliance rate to the trial protocol in a multicenter, multinational cohort in preparation for a large randomized controlled trial.

Detailed Description

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Conditions

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Acute Kidney Injury (Nontraumatic)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Intervention group

Implementation of the cardiovascular surgery AKI bundle

1. discontinuation of all nephrotoxic agents when possible
2. optimization of volume status and hemodynamic parameters
3. close monitoring of serum creatinine, fluid balance and urinary output
4. avoidance of hyperglycemia
5. considerations of alternatives to radiocontrast agents
6. discontinuation of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in the perioperative period
7. avoidance of HES, gelatin, and chlorid-rich solutions

Group Type EXPERIMENTAL

Intervention

Intervention Type OTHER

Implementation of the cardiovascular AKI bundle (see arm description)

Control group

The patients will receive standard of care (according to each center)

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Intervention

Implementation of the cardiovascular AKI bundle (see arm description)

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB)
* Urinary \[TIMP-2\] \* \[IGFBP7\] \>= 0.3 4h after CPB
* Written informed consent

Exclusion Criteria

* Preexisting AKI (stage 1 and higher)
* Patients with cardiac assist devices (ECMO, LVAD, RVAD, IABP)
* Pregnancy, breastfeeding
* Known (Glomerulo-)-Nephritis, intersstitial nephritis or vasculitis
* CKD with eGFR \< 20 mL/min
* Dialyses dependent CKD
* Prior kidney transplant within the last 12 months
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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European Society of Intensive Care Medicine

OTHER

Sponsor Role collaborator

University Hospital Muenster

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Zarbock, PhD

Role: STUDY_CHAIR

University Hospital Muenster, Dept. of Anesthesiology

Locations

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CHU Brugmann, Intensive Care Medicine

Brussels, , Belgium

Site Status

AZ Maria Middelares

Ghent, , Belgium

Site Status

Universitair Ziekenhuis Gent

Ghent, , Belgium

Site Status

Universitätsklinikum Bergmannsheil Bochum

Bochum, , Germany

Site Status

Universitätsklinikum Gießen, Klinik für Herz-, Kinderherz- und Gefäßchirurgie

Giessen, , Germany

Site Status

Philipps-Universität Marburg

Marburg, , Germany

Site Status

University Hospital Muenster

Münster, , Germany

Site Status

Ospedale San Raffaele S.r.I., I.R.C.C.S.

Milan, , Italy

Site Status

Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientific

Milan, , Italy

Site Status

Hospital del la Santa Creu i Sant Pau; Unidad de Cuidados Intensivos

Barcelona, , Spain

Site Status

St. Thomas' Hospital

London, , United Kingdom

Site Status

King's College Hospital

London, , United Kingdom

Site Status

Countries

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Belgium Germany Italy Spain United Kingdom

References

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Meersch M, Schmidt C, Hoffmeier A, Van Aken H, Wempe C, Gerss J, Zarbock A. Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial. Intensive Care Med. 2017 Nov;43(11):1551-1561. doi: 10.1007/s00134-016-4670-3. Epub 2017 Jan 21.

Reference Type BACKGROUND
PMID: 28110412 (View on PubMed)

Zarbock A, Kullmar M, Ostermann M, Lucchese G, Baig K, Cennamo A, Rajani R, McCorkell S, Arndt C, Wulf H, Irqsusi M, Monaco F, Di Prima AL, Garcia Alvarez M, Italiano S, Miralles Bagan J, Kunst G, Nair S, L'Acqua C, Hoste E, Vandenberghe W, Honore PM, Kellum JA, Forni LG, Grieshaber P, Massoth C, Weiss R, Gerss J, Wempe C, Meersch M. Prevention of Cardiac Surgery-Associated Acute Kidney Injury by Implementing the KDIGO Guidelines in High-Risk Patients Identified by Biomarkers: The PrevAKI-Multicenter Randomized Controlled Trial. Anesth Analg. 2021 Aug 1;133(2):292-302. doi: 10.1213/ANE.0000000000005458.

Reference Type DERIVED
PMID: 33684086 (View on PubMed)

Kullmar M, Massoth C, Ostermann M, Campos S, Grau Novellas N, Thomson G, Haffner M, Arndt C, Wulf H, Irqsusi M, Monaco F, Di Prima A, Garcia Alvarez M, Italiano S, Cegarra SanMartin V, Kunst G, Nair S, L'Acqua C, Hoste EAJ, Vandenberghe W, Honore PM, Kellum J, Forni L, Grieshaber P, Weiss R, Gerss J, Wempe C, Meersch M, Zarbock A. Biomarker-guided implementation of the KDIGO guidelines to reduce the occurrence of acute kidney injury in patients after cardiac surgery (PrevAKI-multicentre): protocol for a multicentre, observational study followed by randomised controlled feasibility trial. BMJ Open. 2020 Apr 6;10(4):e034201. doi: 10.1136/bmjopen-2019-034201.

Reference Type DERIVED
PMID: 32265240 (View on PubMed)

Other Identifiers

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07-AnIt-16

Identifier Type: -

Identifier Source: org_study_id

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