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

Spatial and temporalvariation of dissolved inorganic nutrients, and chlorophyll-α in a tropical estuary in northeastern brazil: dynamics of nutrient removal

Monthly sampling campaigns were carried out between February 2010 and January 2011 to evaluate the spatial and temporal distribution of nutrients (ammonium, nitrite, nitrate, dissolved organic nitrogen, phosphate, dissolved organic phosphorus and silicate) and chlorophyll-α along a salinity gradient in the tropical Cachoeira River estuary, subject to the untreated effluents of a sewage treatment plant (STP). During the study period the lowest and highest river discharge occurred in February and April 2010, respectively. High river outflow promoted increased concentrations of inorganic nitrogen and silicate but did not affect the concentration of phosphate. Based on the chlorophyll-α concentration the estuary may be classified as eutrophic / hypereutrophic in its inner portion and mesotrophic in the lower region. The inner portion is more affected by the nutrient load carried out by the river and STP, while dilution by seawater contributed to the reduction of the nutrient concentrations in the lower reaches of the estuary. The results indicate that nutrient uptake by the phytoplankton is the most effective dissolved inorganic nutrient removal processes, especially for phosphate. Mixing diagrams suggest that the coupling of nitrification and denitrification processes is also responsible for the elimination of nitrogen from this ecosystem.Campanhas de amostragens mensais foram realizadas entre fevereiro de 2010 e janeiro de 2011 para avaliar a distribuição espacial e temporal de nutrientes (amônia, nitrito, nitrato, nitrogênio orgânico dissolvido, fosfato, fósforo orgânico dissolvido e silicato) e clorofila-α, ao longo do gradiente de salinidade no estuário tropical do Rio Cachoeira. Este estuário é sujeito aos efluentes de esgotos não tratados de uma estação de tratamento de esgoto (ETE). No período estudado a maior e menor vazão do rio ocorreram em fevereiro e abril de 2010, respectivamente. A alta vazão do rio promoveu aumento das concentrações de nitrogênio inorgânico e silicato, mas não afetou as concentrações de fosfato. Baseado nas concentrações de clorofila-α, o estuário pode ser classificado como eutrófico/hipereutrófico na porção interna e mesotrófico na região externa. A porção interna é mais afetada pela carga de nutrientes do rio e da ETE, enquanto a diluição pela água marinha contribuiu para diminuir as concentrações de nutrientes na porção externa. Os resultados indicam que a absorção de nutrientes pelo fitoplâncton é o processo mais eficiente na remoção desses nutrientes, especialmente do fosfato. No entanto, os diagramas de mistura sugerem que a nitrificação e denitrificação acopladas no rio também são responsáveis pela eliminação do nitrogênio do ecossistema

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.