Perioperative medicine & outcomes
A preventive care strategy to reduce moderate or severe acute kidney injury after major surgery (BigpAK-2); a multinational, randomised clinical trial
Primary result · Moderate or severe AKIResult — go to the resultOdds ratio 0.57 95% CI 0.40–0.79Authors' conclusion
Among adults at high risk for AKI undergoing major surgery, a preventive care strategy consisting of supportive measures and avoidance of nephrotoxins significantly reduced the occurrence of moderate or severe AKI without increasing adverse events.
Study context
- Population
- Adults (≥18 years) undergoing major surgery at high risk for acute kidney injury (AKI) by clinical risk factors and tubular stress biomarkers, 34 hospitals in Europe1,176 analysed
- Participants
- 1,180 adults
- Comparison
- KDIGO-based preventive care strategy vs usual care
- Interventionn = 589
- Controln = 591reference
- Primary endpoint
- Moderate or severe AKI
- Follow-up
- 72 h after surgery
Methodological detailsmulticentre, multinational
- Multicentre
- Multinational
Primary result
As reported in the abstract
Odds ratio
0.57
95% CI 0.40–0.79
P = 0.0002
Events by treatment group
Intervention vs Control
OR 0.57 (95% CI 0.40–0.79); P = 0.0002
Safety
AF
Haemodynamically relevant arrhythmias
Significant bleeding or haemorrhage
Unplanned return to the operating room
Adverse events
- No differences in adverse events
Original publication
A preventive care strategy to reduce moderate or severe acute kidney injury after major surgery (BigpAK-2); a multinational, randomised clinical trial. Lancet. Published 13 November 2025. doi:10.
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