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People with acute kidney injury receiving renal replacement therapy have an increased long-term risk of dying regardless of the type of RRT they receive, according to a new study.
Intensity of RRT performed in intensive care units, researchers also found, made no difference in the likelihood of a patient needing maintenance dialysis or having protein in the urine within 4 years after the intervention.
The results, published Feb. 11 in PLoS Medicine (2014 Feb. 11 [doi: 10.1371/journal.pmed.1001601]), come from extended follow-up in a trial of 1,464 AKI patients in ICUs who were randomized to receive RRT of higher or lower intensity. Dr. Martin Gallagher of the George Institute for Global Health in Sydney, Australia, led the study.
The researchers did not see high-intensity RRT associated with any improvements in long-term survival: At a median of 43.9 months after randomization, 63% of patients in the lower-intensity group and 62% of patients in the higher-intensity group had died (risk ratio, 1.04; 95% CI, 0.96-1.12; P = .49).
Of the 810 patients who survived more than 90 days past randomization, rates of maintenance dialysis were similarly low: 5.1% for the lower-intensity RRT group and 5.8% for the higher-intensity group (RR, 1.12; 95% CI, 0.63-2.00; P = .69). Both groups, however, saw high rates of albuminuria: 40% and 44%, respectively (P = .48). Chronic proteinuria is an established risk factor for death, cardiovascular disease, and additional dialysis.
Dr. Gallagher and his colleagues wrote in their analysis that the findings "support the view that survivors of AKI are at increased risk and that closer surveillance may be justified. In addition, our findings suggest that chronic proteinuria reduction strategies, which have shown benefit in some patient groups with proteinuria, may warrant investigation as a therapeutic intervention."
The study was supported by the Australian government. One coauthor, Dr. Rinaldo Bellomo, disclosed receiving financial support from Eli Lilly, Cardinal Health, and CSL Bioplasma. The George Institute for Global Health, Dr. Gallagher’s institution, has received research funding from Servier, Novartis, and other companies.
People with acute kidney injury receiving renal replacement therapy have an increased long-term risk of dying regardless of the type of RRT they receive, according to a new study.
Intensity of RRT performed in intensive care units, researchers also found, made no difference in the likelihood of a patient needing maintenance dialysis or having protein in the urine within 4 years after the intervention.
The results, published Feb. 11 in PLoS Medicine (2014 Feb. 11 [doi: 10.1371/journal.pmed.1001601]), come from extended follow-up in a trial of 1,464 AKI patients in ICUs who were randomized to receive RRT of higher or lower intensity. Dr. Martin Gallagher of the George Institute for Global Health in Sydney, Australia, led the study.
The researchers did not see high-intensity RRT associated with any improvements in long-term survival: At a median of 43.9 months after randomization, 63% of patients in the lower-intensity group and 62% of patients in the higher-intensity group had died (risk ratio, 1.04; 95% CI, 0.96-1.12; P = .49).
Of the 810 patients who survived more than 90 days past randomization, rates of maintenance dialysis were similarly low: 5.1% for the lower-intensity RRT group and 5.8% for the higher-intensity group (RR, 1.12; 95% CI, 0.63-2.00; P = .69). Both groups, however, saw high rates of albuminuria: 40% and 44%, respectively (P = .48). Chronic proteinuria is an established risk factor for death, cardiovascular disease, and additional dialysis.
Dr. Gallagher and his colleagues wrote in their analysis that the findings "support the view that survivors of AKI are at increased risk and that closer surveillance may be justified. In addition, our findings suggest that chronic proteinuria reduction strategies, which have shown benefit in some patient groups with proteinuria, may warrant investigation as a therapeutic intervention."
The study was supported by the Australian government. One coauthor, Dr. Rinaldo Bellomo, disclosed receiving financial support from Eli Lilly, Cardinal Health, and CSL Bioplasma. The George Institute for Global Health, Dr. Gallagher’s institution, has received research funding from Servier, Novartis, and other companies.
People with acute kidney injury receiving renal replacement therapy have an increased long-term risk of dying regardless of the type of RRT they receive, according to a new study.
Intensity of RRT performed in intensive care units, researchers also found, made no difference in the likelihood of a patient needing maintenance dialysis or having protein in the urine within 4 years after the intervention.
The results, published Feb. 11 in PLoS Medicine (2014 Feb. 11 [doi: 10.1371/journal.pmed.1001601]), come from extended follow-up in a trial of 1,464 AKI patients in ICUs who were randomized to receive RRT of higher or lower intensity. Dr. Martin Gallagher of the George Institute for Global Health in Sydney, Australia, led the study.
The researchers did not see high-intensity RRT associated with any improvements in long-term survival: At a median of 43.9 months after randomization, 63% of patients in the lower-intensity group and 62% of patients in the higher-intensity group had died (risk ratio, 1.04; 95% CI, 0.96-1.12; P = .49).
Of the 810 patients who survived more than 90 days past randomization, rates of maintenance dialysis were similarly low: 5.1% for the lower-intensity RRT group and 5.8% for the higher-intensity group (RR, 1.12; 95% CI, 0.63-2.00; P = .69). Both groups, however, saw high rates of albuminuria: 40% and 44%, respectively (P = .48). Chronic proteinuria is an established risk factor for death, cardiovascular disease, and additional dialysis.
Dr. Gallagher and his colleagues wrote in their analysis that the findings "support the view that survivors of AKI are at increased risk and that closer surveillance may be justified. In addition, our findings suggest that chronic proteinuria reduction strategies, which have shown benefit in some patient groups with proteinuria, may warrant investigation as a therapeutic intervention."
The study was supported by the Australian government. One coauthor, Dr. Rinaldo Bellomo, disclosed receiving financial support from Eli Lilly, Cardinal Health, and CSL Bioplasma. The George Institute for Global Health, Dr. Gallagher’s institution, has received research funding from Servier, Novartis, and other companies.
FROM PLOS MEDICINE