EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

La ciudad del turismo: arquitectura, patrimonio urbano y espacio público

368 p.El turismo cultural ha generado en nuestra época múltiples efectos sobre los ámbitos de la arquitectura, el patrimonio arquitectónico y urbano, y sobre el espacio público de la ciudad. Conscientes de esos impactos, con diferentes métodos de análisis y enfoques (desde la geografía urbana, la historia de la arquitectura y de la ciudad, el urbanismo, las teorías del patrimonio y la restauración), los textos que se recogen en esta monografía, reflexionan sobre diversos aspectos relacionados con la influencia de los fenómenos turísticos en ciudades como Madrid, París, Berlín, Sevilla, Oporto o Baja Ensenada (México). Las diversas contribuciones se centran en las características físicas e ideológicas de las diferentes intervenciones sobre bienes patrimoniales construidos, urbanos o paisajísticos implicados en el consumo turístico. Por otra parte, se evalúan de manera crítica los procesos y factores que intervienen no sólo en los criterios de recuperación de los bienes sino también en la construcción de la imagen y de los imaginarios que son capaces de desencadenar. Las nuevas actuaciones de modernización de la ciudad, la apropiación de memorias selectivas frente a la densidad histórica de los lugares, o la aparición de singulares equipamientos y espacios globales insta a la necesidad de insertar la investigación urbana y arquitectónica en las políticas de remodelación de la ciudad para usos turísticos o culturales. Esta publicación, por ello, presenta nuevas líneas de investigación aspirantes a ofrecer una visión transversal y crítica sobre nuestro entorno global modificado por las políticas y las estrategias de consumo cultural.Este volumen recoge los resultados de los siguientes proyectos de investigación: La influencia del turismo en la transformación del espacio urbano. Ficciones patrimoniales. Universidad de Alcalá y Casa de Velázquez - École des Hautes Études Hispaniques et Ibériques (2016-2018). Referencia: UAH-Casa de Velázquez (2016/00265/001); y Edificios culturales y espacio público urbano: parámetros de análisis y evaluación de los procesos generados por intervenciones urbano-arquitectónicas (2018-2019). Universidad de Alcalá (Ref. CCGP2017-EXP/035), vinculados al grupo de investigación Arquitectura, Historia, Ciudad y Paisaje-ARHCIPAI (Grupo Alto Rendimiento UAH

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI): Study protocol for a multicentre, observational trial

Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369.