In the multinational randomized clinical trial BigpAK-2, preventive care was tested in adult patients at high risk of acute kidney injury (AKI) after major surgery. This strategy included supportive measures and avoidance of nephrotoxic agents. The results showed that this intervention significantly reduced the incidence of moderate or severe AKI. At the same time, there was no increase in adverse effects associated with the treatment. The study confirmed that systematic prevention can improve outcomes in patients at risk of kidney damage after surgery. AKI is defined as a sudden deterioration in kidney function that can lead to serious complications, including an increased risk of chronic kidney disease and mortality. Prevention includes monitoring kidney function and minimizing exposure to nephrotoxins such as certain drugs and contrast agents. This study emphasizes the importance of preventive measures in perioperative care in high-risk patients.