Biomarkers Could Identify Patients at High Risk of Severe AKI After Major Surgery

Even mild impairment of kidney function can lead to long-term dialysis dependence, longer hospital stays, and increased risk of death. Despite its impact, postoperative kidney injury is often detected too late for effective prevention. New evidence now shows that using a biomarker-based approach to identify vulnerable patients early and intervene promptly can significantly reduce the risk of serious kidney damage.

Researchers at the University of Münster (Münster, Germany), together with an international network of European hospitals, investigated whether a structured preventive strategy could protect high-risk surgical patients from kidney injury. The approach relies on biomarkers, specific molecules in the blood or urine that signal early kidney stress or damage, to flag patients at greatest risk immediately after surgery.

The international, multicenter BigpAK-2 study included 7,873 patients undergoing major surgery at 34 hospitals across Europe, with 1,180 classified as high risk based on clinical factors and positive biomarkers. These patients were randomly assigned to standard care or a coordinated prevention protocol during the critical postoperative period. This included careful control of blood circulation and fluid balance, close monitoring of kidney function, and avoidance of medications known to strain the kidneys. The protocol was designed to be practical and feasible in routine hospital settings without the need for specialized equipment.

The findings, published in The Lancet, show that patients who received the targeted preventive care were significantly less likely to develop moderate or severe acute kidney injury within the first 72 hours after surgery. Importantly, the intervention did not increase complications or side effects, demonstrating that the strategy is both effective and safe. The results suggest that postoperative kidney injury can be prevented in many cases by acting early, during the narrow window when the kidneys are most vulnerable.

Because the protocol is based on monitoring, teamwork, and timely decision-making rather than advanced technology, it can be widely implemented across healthcare systems. The research team hopes the findings will be incorporated into international clinical guidelines. If adopted broadly, this biomarker-guided prevention strategy could improve outcomes for millions of surgical patients worldwide and reduce the long-term burden of kidney disease.

“Acute kidney injury after surgery is a frequently underestimated problem,” said Prof Alexander Zarbock, lead author of the study. “We were able to show that the intervention can be implemented in hospitals across Europe. It does not require high-tech equipment, but rather early identification of high-risk patients using innovative biomarkers and a well-coordinated team that acts attentively in the first hours after surgery.”

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