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

Blood purification methods in complex treatment of patients with a new coronavirus infection

Blood purification methods are widely used for sepsis, systemic inflammatory response and multiple organ failure. The new coro-navirus infection followed by sepsis or septic shock in severe cases is characterized by imbalance in concentrations of pro-and an-ti-inflammatory mediators (the so-called cytokine storm). These processes result the development and progression of multiple organ failure. Special attention is paid to impaired renal function, since acute renal damage in COVID-19 is a predictor of an ad-verse outcome. In this situation, blood purification methods are advisable for discontinuation of cytokine storm on the one hand and treatment/prevention of acute kidney injury on the other one. The authors describe blood purification methods which are cur-rently used in the treatment of sepsis and septic shock and can be used for COVID-19. Effectiveness of some of these techniques have been already confirmed. The issues of acute renal injury and options for renal replacement therapy are also considered