The bio-sonographic index. A novel modality for early detection of acute kidney injury after complex vascular surgery. A protocol for an exploratory prospective study

Abstract

Objective: Acute kidney injury (AKI) is a common complication of complex aortic surgery with high mortality, morbidity and health care expense. The current definition of AKI does not allow for structural characterization of the kidneys and utilizes functional indices with substantial limitations leading to delayed diagnosis and ineffective interventions. The aim of this study is to develop a method of early detection of structural renal abnormalities that can precede and predict the occurrence of AKI in this population. We propose a novel combined index of ultrasonography (shear wave elastography), biomarkers of renal stress (urinary insulin growth factor binding protein-7, IGFBP-7 and inhibitor of tissue metalloproteinase-2, TIMP-2) and renal injury markers (urinary neutrophil gelatinase-associated lipocalin -NGAL)- the bio-sonographic index (BSI).

Methods: A prospective observational study at a tertiary referral center will be performed enrolling 80 patients undergoing elective open and endovascular repair of the visceral aorta. The BSI will be evaluated at baseline, and at 6 and 24 hours after the procedure. The primary outcome is the occurrence of AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Each patient will be his/her own control. A reference group of 15 healthy volunteers who are not undergoing interventions will be enrolled to test the feasibility of and to refine the novel SWE protocol. The BSI will be tested for its predictability of the occurrence of AKI. Comparisons will be made between individual and combined components of the BSI and traditional markers used in the KDIGO definition; serum creatinine and urine output in terms of baseline status of the kidney. Correlations will be made between the BSI and conventional indices of AKI and exploratory analyses will be conducted to identify individual disease patterns using the BSI.

Discussion: We hypothesize that the BSI will be a sensitive index of early structural abnormalities that precede and predict the occurrence of AKI as defined by KDIGO in complex vascular surgery.

Trial registration: ClinicalTrials.gov NCT04144894. Registered 1/6/2020.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Proposal summary of the study.

eGR: Estimated glomerular filtration rate, SWE; Shear wave elastography; uIGFBP-2/TIMP-7: urinary Insulin growth factor binding protein-7/tissue inhibitor of metalloproteinase-7; NGAL: neutrophil gelatinase-associated lipocalin; AAA: open Abdominal aortic aneurysm repair; TAA: Thoracoabdominal aneurysm repair; TEVAR: Thoracic endovascular aneurysm repair; PAKI: Postoperative acute kidney injury; KDIGO: Kidney Disease Improving Global Outcomes; EVAR: endovascular abdominal aneurysm repair, FEVAR: fenestrated endovascular abdominal aneurysm repair.