Implementation of a kidney protection strategy to prevent acute kidney injury after major surgery in high-risk patients identified by biomarkers: a systematic review and individual participant data meta-analysis of randomized controlled trials

doi:10.1007/s00134-026-08399-1

Implementation of a kidney protection strategy to prevent acute kidney injury after major surgery in high-risk patients identified by biomarkers: a systematic review and individual participant data meta-analysis of randomized controlled trials

Intensive Care MedPublished 20 Apr 2026Systematic review and individual participant data meta-analysis of randomised controlled trials

Pooled resultResultOdds ratio 0.55 95% CI 0.44–0.70

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Authors' conclusion

The implementation of a kidney protection strategy reduces the rates of moderate or severe AKI in biomarker-enriched high-risk patients after major surgery compared to standard of care, while the incremental clinical value of biomarker-guided selection itself remains uncertain.

Study context

Population: High-risk patients after major surgery identified by renal biomarkers
Participants: 1,851 patients · 4 randomized controlled trials (RCTs)

Comparison: KDIGO kidney protection strategy vs standard care
Interventionn = 921
Controln = 930reference
Outcome: Moderate or severe AKI (KDIGO stage ≥ 2)
Follow-up: 72 h after surgery

Methodological detailsone-stage individual participant data (IPD) meta-analysis, biomarker-based enrichment strategy, GRADE

One-stage IPD meta-analysis
Biomarker-based enrichment strategy
GRADE

Pooled result

As reported in the abstract

Odds ratio

0.55

95% CI 0.44–0.70

P < 0.0001

Events by group

Intervention17.7%162

Control27.1%252 of 930

Intervention vs Control

OR 0.55 (95% CI 0.44–0.70); P < 0.0001

No evidence of heterogeneity across studies: I2 = 0.0%

Further pooled results

Secondary endpoints

Varied across trials; no major differences between groups

Persistent acute kidney injury (AKI) and renal tubular stress biomarkers

Intervention tended to result in fewer persistent AKI events and larger decreases in renal tubular stress biomarkers

When measured

Original publication

Implementation of a kidney protection strategy to prevent acute kidney injury after major surgery in high-risk patients identified by biomarkers: a systematic review and individual participant data meta-analysis of randomized controlled trials. Intensive Care Med. Published 20 April 2026. doi:10.1007/s00134-026-08399-1

Read the original article ↗

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