(Revival) Study to Investigate the Efficacy and Safety of Alkaline Phosphatase in Patients With Sepsis-Associated AKI

Exclusion Criteria

• •1. a) At sites where enrolment of 'moderate' CKD patients is allowed, patients with 'severe' CKD defined as a pre-AKI reference eGFR \<25 mL/min/1.73 m2 are excluded.
• •* For patients with known CKD, the most recent eGFR prior to index hospitalization needs to be documented as ≥25 mL/min/1.73 m2.
• •* For patients with known CKD but no known eGFR prior to hospitalization, presentation eGFR between 25-60 mL/min/1.73 m2 can also be used to rule out 'severe' CKD.
• •b) At sites where enrolment of 'moderate' CKD patients is NOT allowed, patients with 'moderate' and 'severe' CKD defined as a pre-AKI reference eGFR \<45 mL/min/1.73 m2 are excluded.
• •* For patients with known CKD, the most recent eGFR prior to index hospitalization needs to be documented as ≥45 mL/min/1.73 m2.
• •* For patients with known CKD but no known eGFR prior to hospitalization, presentation eGFR between 45-60 mL/min/1.73 m2 can also be used to rule out 'moderate' and 'severe' CKD.
• •2. Advanced chronic liver disease, defined as a Child-Pugh score of 10 to 15 (Class C).
• •3. Acute pancreatitis without proven infection.
• •4. Urosepsis related to suspected or proven urinary tract obstruction.
• •5. Main cause of AKI not sepsis.
• •6. Proven or suspected SARS-CoV-2 infection. NOTE: This exclusion criterion does not apply to patients in the COVID-19 population, in which COVID-19 should be the main cause of SA-AKI.
• •7. Severe burns requiring ICU treatment.
• •8. Severely immunosuppressed, e.g. due to:
• •* hematopoietic cell transplantation within past 6 months prior to Screening or acute or chronic graft-versus-host disease
• •* solid organ transplantation
• •* leukopenia not related to sepsis, i.e., preceding sepsis
• •* Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS)
• •* receiving chemotherapy within 30 days prior to Screening.
• •9. At high risk of being LTFU, e.g., due to known current or recent (within the last 6 months) IV drug abuse or known to be homeless.
• •10. Limitations to use of mechanical ventilation (MV), RRT or vasopressors and inotropes (NOTE: limitation of cardiopulmonary resuscitation (CPR) only is not an exclusion criterion).
• •11. Previous administration of recAP.
• •12. Use of a non-marketed drug within the last month or concurrent or planned participation in a clinical trial for a non-marketed drug or device. (NOTE: Co-enrollment or concurrent participation in observational, non-interventional trials using no protocolized treatments or procedures are always allowed. Co-enrollment or concurrent participation in trials using protocolized treatments or procedures, e.g. blood draws, requires pre-approval by the TSC).
• •13. Current or planned extracorporeal membrane oxygenation (ECMO).
• •14. On RRT \>24 hours before start of trial drug.
• •15. No longer on vasopressor therapy at time of randomization.
• •16. On continuous vasopressor therapy for \>72 hours before start of trial drug.
• •17. Estimated glomerular filtration rate (eGFR) \>60 mL/min/1.73 m2 based on the most recent available CR sample at time of screening (NOTE: will often be the sample used to diagnose AKI). eGFR should be calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. In Japan, the CKD-EPI formula with Japanese coefficient should be used. If local regulations prohibit correcting for race in the calculation of eGFR, it is acceptable to use the formula without correcting for race.
• •18. Not feasible to start trial drug within:
• •1. 48 hours from AKI diagnosis, when AKI diagnosis precedes start of vasopressor therapy.
• •or
• •2. 24 hours from AKI diagnosis, when AKI is diagnosed after start of vasopressor therapy.
• •19. Pregnant or nursing women.