急性肾损伤(AKI)是心脏手术后常见的并发症,短期和长期预后不良。尽管强烈建议预防AKI(PrevAKI),最优策略是不确定的。肾脏疾病:改善全球结果(KDIGO)指南建议对高危患者采取一系列支持措施。在单中心审判中,我们最近证明,严格执行KDIGO束能显著减少心脏手术后AKI的发生.在这个可行性研究中,我们的目的是评估研究方案是否可以在多中心环境中实施,为大型多中心试验做准备.
我们计划进行一次前瞻性的,观察性调查,然后进行随机对照调查,多中心,多国临床试验,包括280例接受体外循环心脏手术的患者。观察性调查的目的是探索常规临床实践中对KDIGO建议的遵守情况。第二阶段是随机对照试验。目的是调查试验方案是否可在大型多中心实施,跨国设置。介入部分的主要终点是对协议的遵守率。次要终点包括手术后72小时内KDIGO标准定义的任何AKI和中度/重度AKI的发生。第90天的肾脏恢复,使用肾脏替代治疗(RRT)和第30、60和90天的死亡率,包括持续肾功能不全的综合终点主要不良肾脏事件,RRT和第90天的死亡率和安全性结果。
PrevAKI多中心研究已获得明斯特大学领先的研究伦理委员会和每个参与地点的研究伦理委员会的批准。结果将被用来设计一个大的,最终审判。
NCT03244514。
Acute kidney injury (AKI) is a frequent complication after cardiac surgery with adverse short-term and long-term outcomes. Although prevention of AKI (PrevAKI) is strongly recommended, the optimal strategy is uncertain. The Kidney Disease: Improving Global Outcomes (KDIGO)
guideline recommended a bundle of supportive measures in high-risk patients. In a single-centre trial, we recently demonstrated that the strict implementation of the KDIGO bundle significantly reduced the occurrence of AKI after cardiac surgery. In this feasibility study, we aim to evaluate whether the study protocol can be implemented in a multicentre setting in preparation for a large multicentre trial.
We plan to conduct a prospective, observational survey followed by a randomised controlled, multicentre, multinational clinical trial including 280 patients undergoing cardiac surgery with cardiopulmonary bypass. The purpose of the observational survey is to explore the adherence to the KDIGO recommendations in routine clinical practice. The second phase is a randomised controlled trial. The objective is to investigate whether the trial protocol is implementable in a large multicentre, multinational setting. The primary endpoint of the interventional part is the compliance rate with the protocol. Secondary endpoints include the occurrence of any AKI and moderate/severe AKI as defined by the KDIGO criteria within 72 hours after surgery, renal recovery at day 90, use of renal replacement therapy (RRT) and mortality at days 30, 60 and 90, the combined endpoint major adverse kidney events consisting of persistent renal dysfunction, RRT and mortality at day 90 and safety outcomes.
The PrevAKI multicentre study has been approved by the leading Research Ethics Committee of the University of Münster and the respective Research Ethics Committee at each participating site. The results will be used to design a large, definitive trial.
NCT03244514.