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

Fine scale population structure of bottlenose dolphins (Tursiops truncatus) off Galician waters, NW Spain

Bottlenose dolphins are known to have high dispersal capabilities that could lead to genetic connectivity. However, local resident populations are found worldwide as happens in southern Galicia (NW Spain). The aim of this research is to explore whether population substructure and habitat segregation do exist within the Galician bottlenose dolphin community. In the present study, samples from 43 bottlenose dolphins stranded or by-caught in Galicia between 1994 and 2008 were genotyped at 10 microsatellite loci and sequenced at the highly variable mitochondrial control region. In addition, variability of stable isotope ratios (δ13C and δ15N) was assessed for 43 dolphins (5 calves, 38 juveniles and adults) stranded or by-caught in Galicia between 1998 and 2007. Genetic results highlighted the existence of two populations in the area and dolphins from southern Galicia were assigned to a single genetic group. Seven dolphins were classified as possible migrants between putative populations as their genetic makeup did not correspond with their geographical stranding location. Values of δ13C and δ15N were significantly different between the two populations, suggesting resource specialization and partitioning. Dolphins from southern Galicia (inhabiting coastal inlets) showed more variation in their diet, higher trophic levels and greater δ13C compared to animals from northern Galicia (present in more open waters). The existence of fine scale population substructure should be considered in the future designation of Special Areas of Conservation (SACs) for the species as required by the European Habitats Directive

Stable isotope analysis in two sympatric populations of bottlenose dolphins Tursiops truncatus: evidence of resource partitioning?

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