Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care

Extended Follow-up of a Randomized Controlled Trial

Martin Gallagher, Alan Cass, Rinaldo Bellomo, Simon Finfer, David Gattas, Joanne Lee, Serigne Lo, Shay McGuinness, John Myburgh, Rachael Parke, Dorrilyn Rajbhandari

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    Abstract

    Background: The incidence of acute kidney injury (AKI) is increasing globally and it is much more common than end-stage kidney disease. AKI is associated with high mortality and cost of hospitalisation. Studies of treatments to reduce this high mortality have used differing renal replacement therapy (RRT) modalities and have not shown improvement in the short term. The reported long-term outcomes of AKI are variable and the effect of differing RRT modalities upon them is not clear. We used the prolonged follow-up of a large clinical trial to prospectively examine the long-term outcomes and effect of RRT dosing in patients with AKI.

    Methods and Findings: 
    We extended the follow-up of participants in the Randomised Evaluation of Normal vs. Augmented Levels of RRT (RENAL) study from 90 days to 4 years after randomization. Primary and secondary outcomes were mortality and requirement for maintenance dialysis, respectively, assessed in 1,464 (97%) patients at a median of 43.9 months (interquartile range [IQR] 30.0–48.6 months) post randomization. A total of 468/743 (63%) and 444/721 (62%) patients died in the lower and higher intensity groups, respectively (risk ratio [RR] 1.04, 95% CI 0.96–1.12, p = 0.49). Amongst survivors to day 90, 21 of 411 (5.1%) and 23 of 399 (5.8%) in the respective groups were treated with maintenance dialysis (RR 1.12, 95% CI 0.63–2.00, p = 0.69). The prevalence of albuminuria among survivors was 40% and 44%, respectively (p = 0.48). Quality of life was not different between the two treatment groups. The generalizability of these findings to other populations with AKI requires further exploration.

    Conclusions:
     Patients with AKI requiring RRT in intensive care have high long-term mortality but few require maintenance dialysis. Long-term survivors have a heavy burden of proteinuria. Increased intensity of RRT does not reduce mortality or subsequent treatment with dialysis.
    Original languageEnglish
    Article numbere1001601
    Pages (from-to)1-13
    Number of pages13
    JournalPLoS Medicine
    Volume11
    Issue number2
    DOIs
    Publication statusPublished - 11 Feb 2014

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    Renal Replacement Therapy
    Critical Care
    Acute Kidney Injury
    Dialysis
    Randomized Controlled Trials
    Survival
    Mortality
    Survivors
    Maintenance
    Random Allocation
    Odds Ratio
    Albuminuria
    Proteinuria
    Chronic Kidney Failure
    Hospitalization
    Therapeutics
    Quality of Life
    Clinical Trials
    Costs and Cost Analysis
    Incidence

    Cite this

    Gallagher, Martin ; Cass, Alan ; Bellomo, Rinaldo ; Finfer, Simon ; Gattas, David ; Lee, Joanne ; Lo, Serigne ; McGuinness, Shay ; Myburgh, John ; Parke, Rachael ; Rajbhandari, Dorrilyn. / Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care : Extended Follow-up of a Randomized Controlled Trial. In: PLoS Medicine. 2014 ; Vol. 11, No. 2. pp. 1-13.
    @article{12839d0010b04b5fabef16c7f76af317,
    title = "Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care: Extended Follow-up of a Randomized Controlled Trial",
    abstract = "Background: The incidence of acute kidney injury (AKI) is increasing globally and it is much more common than end-stage kidney disease. AKI is associated with high mortality and cost of hospitalisation. Studies of treatments to reduce this high mortality have used differing renal replacement therapy (RRT) modalities and have not shown improvement in the short term. The reported long-term outcomes of AKI are variable and the effect of differing RRT modalities upon them is not clear. We used the prolonged follow-up of a large clinical trial to prospectively examine the long-term outcomes and effect of RRT dosing in patients with AKI.Methods and Findings: We extended the follow-up of participants in the Randomised Evaluation of Normal vs. Augmented Levels of RRT (RENAL) study from 90 days to 4 years after randomization. Primary and secondary outcomes were mortality and requirement for maintenance dialysis, respectively, assessed in 1,464 (97{\%}) patients at a median of 43.9 months (interquartile range [IQR] 30.0–48.6 months) post randomization. A total of 468/743 (63{\%}) and 444/721 (62{\%}) patients died in the lower and higher intensity groups, respectively (risk ratio [RR] 1.04, 95{\%} CI 0.96–1.12, p = 0.49). Amongst survivors to day 90, 21 of 411 (5.1{\%}) and 23 of 399 (5.8{\%}) in the respective groups were treated with maintenance dialysis (RR 1.12, 95{\%} CI 0.63–2.00, p = 0.69). The prevalence of albuminuria among survivors was 40{\%} and 44{\%}, respectively (p = 0.48). Quality of life was not different between the two treatment groups. The generalizability of these findings to other populations with AKI requires further exploration.Conclusions: Patients with AKI requiring RRT in intensive care have high long-term mortality but few require maintenance dialysis. Long-term survivors have a heavy burden of proteinuria. Increased intensity of RRT does not reduce mortality or subsequent treatment with dialysis.",
    keywords = "acute kidney failure, adult, aged, APACHE, article, death, dialysis, diastolic blood pressure, female, follow up, glomerulus filtration rate, human, incidence, intensive care, long term survival, macroalbuminuria, major clinical study, male, microalbuminuria, middle aged, mortality, outcome assessment, prevalence, prospective study, quality of life, randomized controlled trial, Acute Kidney Injury, Aged, Albuminuria, Australia, Chi-Square Distribution, Female, Humans, Intensive Care Units, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, New Zealand, Odds Ratio, Prevalence, Proportional Hazards Models, Prospective Studies, Renal Dialysis, Risk Factors, Survivors, Time Factors, Treatment Outcome",
    author = "Martin Gallagher and Alan Cass and Rinaldo Bellomo and Simon Finfer and David Gattas and Joanne Lee and Serigne Lo and Shay McGuinness and John Myburgh and Rachael Parke and Dorrilyn Rajbhandari",
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    Gallagher, M, Cass, A, Bellomo, R, Finfer, S, Gattas, D, Lee, J, Lo, S, McGuinness, S, Myburgh, J, Parke, R & Rajbhandari, D 2014, 'Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care: Extended Follow-up of a Randomized Controlled Trial', PLoS Medicine, vol. 11, no. 2, e1001601, pp. 1-13. https://doi.org/10.1371/journal.pmed.1001601

    Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care : Extended Follow-up of a Randomized Controlled Trial. / Gallagher, Martin; Cass, Alan; Bellomo, Rinaldo; Finfer, Simon; Gattas, David; Lee, Joanne; Lo, Serigne; McGuinness, Shay; Myburgh, John; Parke, Rachael; Rajbhandari, Dorrilyn.

    In: PLoS Medicine, Vol. 11, No. 2, e1001601, 11.02.2014, p. 1-13.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care

    T2 - Extended Follow-up of a Randomized Controlled Trial

    AU - Gallagher, Martin

    AU - Cass, Alan

    AU - Bellomo, Rinaldo

    AU - Finfer, Simon

    AU - Gattas, David

    AU - Lee, Joanne

    AU - Lo, Serigne

    AU - McGuinness, Shay

    AU - Myburgh, John

    AU - Parke, Rachael

    AU - Rajbhandari, Dorrilyn

    N1 - NHMRC Grant No.: 63281

    PY - 2014/2/11

    Y1 - 2014/2/11

    N2 - Background: The incidence of acute kidney injury (AKI) is increasing globally and it is much more common than end-stage kidney disease. AKI is associated with high mortality and cost of hospitalisation. Studies of treatments to reduce this high mortality have used differing renal replacement therapy (RRT) modalities and have not shown improvement in the short term. The reported long-term outcomes of AKI are variable and the effect of differing RRT modalities upon them is not clear. We used the prolonged follow-up of a large clinical trial to prospectively examine the long-term outcomes and effect of RRT dosing in patients with AKI.Methods and Findings: We extended the follow-up of participants in the Randomised Evaluation of Normal vs. Augmented Levels of RRT (RENAL) study from 90 days to 4 years after randomization. Primary and secondary outcomes were mortality and requirement for maintenance dialysis, respectively, assessed in 1,464 (97%) patients at a median of 43.9 months (interquartile range [IQR] 30.0–48.6 months) post randomization. A total of 468/743 (63%) and 444/721 (62%) patients died in the lower and higher intensity groups, respectively (risk ratio [RR] 1.04, 95% CI 0.96–1.12, p = 0.49). Amongst survivors to day 90, 21 of 411 (5.1%) and 23 of 399 (5.8%) in the respective groups were treated with maintenance dialysis (RR 1.12, 95% CI 0.63–2.00, p = 0.69). The prevalence of albuminuria among survivors was 40% and 44%, respectively (p = 0.48). Quality of life was not different between the two treatment groups. The generalizability of these findings to other populations with AKI requires further exploration.Conclusions: Patients with AKI requiring RRT in intensive care have high long-term mortality but few require maintenance dialysis. Long-term survivors have a heavy burden of proteinuria. Increased intensity of RRT does not reduce mortality or subsequent treatment with dialysis.

    AB - Background: The incidence of acute kidney injury (AKI) is increasing globally and it is much more common than end-stage kidney disease. AKI is associated with high mortality and cost of hospitalisation. Studies of treatments to reduce this high mortality have used differing renal replacement therapy (RRT) modalities and have not shown improvement in the short term. The reported long-term outcomes of AKI are variable and the effect of differing RRT modalities upon them is not clear. We used the prolonged follow-up of a large clinical trial to prospectively examine the long-term outcomes and effect of RRT dosing in patients with AKI.Methods and Findings: We extended the follow-up of participants in the Randomised Evaluation of Normal vs. Augmented Levels of RRT (RENAL) study from 90 days to 4 years after randomization. Primary and secondary outcomes were mortality and requirement for maintenance dialysis, respectively, assessed in 1,464 (97%) patients at a median of 43.9 months (interquartile range [IQR] 30.0–48.6 months) post randomization. A total of 468/743 (63%) and 444/721 (62%) patients died in the lower and higher intensity groups, respectively (risk ratio [RR] 1.04, 95% CI 0.96–1.12, p = 0.49). Amongst survivors to day 90, 21 of 411 (5.1%) and 23 of 399 (5.8%) in the respective groups were treated with maintenance dialysis (RR 1.12, 95% CI 0.63–2.00, p = 0.69). The prevalence of albuminuria among survivors was 40% and 44%, respectively (p = 0.48). Quality of life was not different between the two treatment groups. The generalizability of these findings to other populations with AKI requires further exploration.Conclusions: Patients with AKI requiring RRT in intensive care have high long-term mortality but few require maintenance dialysis. Long-term survivors have a heavy burden of proteinuria. Increased intensity of RRT does not reduce mortality or subsequent treatment with dialysis.

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    KW - adult

    KW - aged

    KW - APACHE

    KW - article

    KW - death

    KW - dialysis

    KW - diastolic blood pressure

    KW - female

    KW - follow up

    KW - glomerulus filtration rate

    KW - human

    KW - incidence

    KW - intensive care

    KW - long term survival

    KW - macroalbuminuria

    KW - major clinical study

    KW - male

    KW - microalbuminuria

    KW - middle aged

    KW - mortality

    KW - outcome assessment

    KW - prevalence

    KW - prospective study

    KW - quality of life

    KW - randomized controlled trial

    KW - Acute Kidney Injury

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    KW - Albuminuria

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    KW - Chi-Square Distribution

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    KW - Intensive Care Units

    KW - Kaplan-Meier Estimate

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    KW - Multivariate Analysis

    KW - New Zealand

    KW - Odds Ratio

    KW - Prevalence

    KW - Proportional Hazards Models

    KW - Prospective Studies

    KW - Renal Dialysis

    KW - Risk Factors

    KW - Survivors

    KW - Time Factors

    KW - Treatment Outcome

    U2 - 10.1371/journal.pmed.1001601

    DO - 10.1371/journal.pmed.1001601

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    JO - PLoS Medicine

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    SN - 1549-1277

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