{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T18:48:42Z","timestamp":1764355722611,"version":"3.46.0"},"reference-count":17,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009128","name":"Research for Patient Benefit Programme","doi-asserted-by":"publisher","award":["NIHR206198"],"award-info":[{"award-number":["NIHR206198"]}],"id":[{"id":"10.13039\/501100009128","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,28]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Peripheral arterial disease (PAD) commonly coexists with chronic kidney disease (CKD). Patients with symptomatic PAD often require endovascular revascularisation to relieve pain or salvage limbs. However, the iodinated intra-arterial contrast routinely used in these procedures is nephrotoxic, placing patients with CKD at increased risk of acute kidney injury (AKI) and long-term renal decline. Carbon dioxide (CO\n                      <jats:sub>\u2082<\/jats:sub>\n                      ) delivered via automated injection is a potential alternative imaging contrast medium. This trial will evaluate whether using CO\n                      <jats:sub>\u2082<\/jats:sub>\n                      instead of iodinated contrast reduces the risk of AKI and short-term renal function decline in this high-risk group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      This is a multicentre, open-label, prospective randomised controlled trial across six secondary-care National Health Service (NHS) vascular surgery centres. A total of 174 patients with PAD and CKD undergoing endovascular intervention will be randomised 1:1 to receive iodinated contrast (standard of care) or CO\n                      <jats:sub>\u2082<\/jats:sub>\n                      via automated injector (Angiodroid). All perioperative care will follow local NHS protocols.\n                    <\/jats:p>\n                    <jats:p>\n                      The primary outcome is log serum creatinine at 2, 30 and 90 days postprocedure. Key secondary outcomes include: incidence and severity of AKI within 48 hours postprocedure, major adverse kidney events (death, dialysis or &gt;25% estimated glomerular filtration rate decline) by 90 days, inpatient length of stay, procedural pain, quality of life, procedural success, reinterventions, acceptability and feasibility (patient\/practitioner questionnaires) of using CO\n                      <jats:sub>2<\/jats:sub>\n                      , and cost-effectiveness (healthcare resource use analysis). A mixed-methods process evaluation will be undertaken with patients and clinicians.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The trial has been approved by an NHS ethical review committee (24\/WA\/0332) and patients have been involved in trial design. Findings will be disseminated to participants, clinicians and the wider public through patient groups, lay summaries, social media, conferences, peer-reviewed journals and NHS policy channels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN23564393\">ISRCTN23564393<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-111752","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T18:40:55Z","timestamp":1764355255000},"page":"e111752","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Preventing kidney injury using carbon dioxide (KID trial): trial protocol for a multicentre randomised controlled trial"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"isrctn23564393","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3399-094X","authenticated-orcid":false,"given":"Athanasios","family":"Saratzis","sequence":"first","affiliation":[{"name":"Cardiovascular Sciences, University of Leicester Medical School, Leicester, Leicestershire, UK"},{"name":"University of Leicester, Leicester, Leicestershire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neha","family":"Rasheed","sequence":"additional","affiliation":[{"name":"University of Leicester, Leicester, Leicestershire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dania","family":"Aguirre","sequence":"additional","affiliation":[{"name":"University of Leicester, Leicester, Leicestershire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Coughlin","sequence":"additional","affiliation":[{"name":"Vascular Surgery, Leeds Vascular Institute General Infirmary, Leeds, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athanasios","family":"Diamantopoulos","sequence":"additional","affiliation":[{"name":"Guy\u2019s and St Thomas\u2019 Hospitals NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsay","family":"Bearne","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, King\u2019s College London, London, UK"},{"name":"St George\u2019s University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0351-8326","authenticated-orcid":false,"given":"Nicholas M","family":"Selby","sequence":"additional","affiliation":[{"name":"Centre for Kidney Research and Innovation, University 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