TY - JOUR
T1 - Epidemiology of RBC transfusions in patients with severe acute kidney injury
T2 - Analysis from the randomized evaluation of normal versus augmented level study
AU - Bellomo, Rinaldo
AU - Mårtensson, Johan
AU - Kaukonen, Kirsi Maija
AU - Lo, Serigne
AU - Gallagher, Martin
AU - Cass, Alan
AU - Myburgh, John
AU - Finfer, Simon
PY - 2016/5
Y1 - 2016/5
N2 - Objective: To assess the epidemiology and outcomes
associated with RBC transfusion in patients with severe acute kidney injury
requiring continuous renal replacement therapy.
Design: Post hoc analysis of data from a multicenter,
randomized, controlled trial. Setting: Thirty-five ICUs in Australia and New
Zealand.
Patients: Cohort of 1,465 patients enrolled in the
Randomized Evaluation of Normal versus Augmented Level replacement therapy
study. Interventions: Daily information on morning hemoglobin level and amount
of RBC transfused were prospectively collected in the Randomized Evaluation of
Normal versus Augmented Level study. We analyzed the epidemiology of such
transfusions and their association with clinical outcomes.
Measurements and Main Results: Overall, 977
patients(66.7%) received a total of 1,192 RBC units. By day 5, 785 of 977
transfused patients (80.4%) had received at least one RBC transfusion.
Hemoglobin at randomization was lower in transfused than in nontransfused
patients (94 vs 111 g/L; p < 0.001). Mean daily hemoglobin was 88 ± 7 and 99
± 12 g/L in transfused and nontransfused patients. Among transfused patients,
228 (46.7%) had died by day 90 when compared with 426 (43.6%) of nontransfused
patients (p = 0.27). Survivors received on average 316 ± 261 mL of RBC, whereas
nonsurvivors received 302 ± 362 mL (p = 0.42). On multivariate Cox regression
analysis, RBC transfusion was independently associated with lower 90-day
mortality (hazard ratio, 0.55; 95% CI, 0.38-0.79). However, we found no
independent association between RBC transfusions and mortality when the
analyses were restricted to patients surviving at least 5 days (hazard ratio,
1.29; 95% CI, 0.90-1.85). We found no independent association between RBC
transfusion and renal replacement therapy-free days, mechanical ventilator-free
days, or length of stay in ICU or hospital.
Conclusions: In patients with severe acute kidney
injury treated with continuous renal replacement therapy, we found no
association of RBC transfusion with 90-day mortality or other patient-centered
outcomes. The optimal hemoglobin threshold for RBC transfusion in such patients
needs to be determined in future randomized controlled trials.
AB - Objective: To assess the epidemiology and outcomes
associated with RBC transfusion in patients with severe acute kidney injury
requiring continuous renal replacement therapy.
Design: Post hoc analysis of data from a multicenter,
randomized, controlled trial. Setting: Thirty-five ICUs in Australia and New
Zealand.
Patients: Cohort of 1,465 patients enrolled in the
Randomized Evaluation of Normal versus Augmented Level replacement therapy
study. Interventions: Daily information on morning hemoglobin level and amount
of RBC transfused were prospectively collected in the Randomized Evaluation of
Normal versus Augmented Level study. We analyzed the epidemiology of such
transfusions and their association with clinical outcomes.
Measurements and Main Results: Overall, 977
patients(66.7%) received a total of 1,192 RBC units. By day 5, 785 of 977
transfused patients (80.4%) had received at least one RBC transfusion.
Hemoglobin at randomization was lower in transfused than in nontransfused
patients (94 vs 111 g/L; p < 0.001). Mean daily hemoglobin was 88 ± 7 and 99
± 12 g/L in transfused and nontransfused patients. Among transfused patients,
228 (46.7%) had died by day 90 when compared with 426 (43.6%) of nontransfused
patients (p = 0.27). Survivors received on average 316 ± 261 mL of RBC, whereas
nonsurvivors received 302 ± 362 mL (p = 0.42). On multivariate Cox regression
analysis, RBC transfusion was independently associated with lower 90-day
mortality (hazard ratio, 0.55; 95% CI, 0.38-0.79). However, we found no
independent association between RBC transfusions and mortality when the
analyses were restricted to patients surviving at least 5 days (hazard ratio,
1.29; 95% CI, 0.90-1.85). We found no independent association between RBC
transfusion and renal replacement therapy-free days, mechanical ventilator-free
days, or length of stay in ICU or hospital.
Conclusions: In patients with severe acute kidney
injury treated with continuous renal replacement therapy, we found no
association of RBC transfusion with 90-day mortality or other patient-centered
outcomes. The optimal hemoglobin threshold for RBC transfusion in such patients
needs to be determined in future randomized controlled trials.
KW - acute kidney injury
KW - continuous renal replacement therapy
KW - critical care
KW - intensive care
KW - renal failure
KW - transfusion
UR - http://www.scopus.com/inward/record.url?scp=84949008815&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000001518
DO - 10.1097/CCM.0000000000001518
M3 - Article
C2 - 26619086
AN - SCOPUS:84949008815
VL - 44
SP - 892
EP - 900
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 5
ER -