Acute kidney injury elevates death risk long after RRT

Acute kidney injury survivors treated with renal replacement therapy in the ICU have high long-term mortality risk, regardless of the type of RRT they received, according to a recent 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 in PLoS Medicine (2014 Feb. 11 [doi:10.1371/journal.pmed.1001601]), come from POST-RENAL, an extended follow-up in a trial of 1,464 adult 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. Patients were treated in 35 centers in Australia or New Zealand between December 2005 and August 2008.

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% confidence interval, 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 significantly high rates of albuminuria: 40% and 44%, respectively (P = .48). Chronic proteinuria is an established risk factor for death, cardiovascular disease, and additional dialysis.

"Only one-third of randomized patients were alive 3.5 years later, a lower survival than that seen in recognized high mortality conditions such as the acute respiratory distress syndrome. Although, in our patients the risk of subsequent maintenance dialysis dependence is low, almost half have evidence of significant proteinuria, portending further risk in the years to come," Dr. Gallagher and his colleagues said in their analysis.

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," they wrote.

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.

Acute kidney injury survivors treated with renal replacement therapy in the ICU have high long-term mortality risk, regardless of the type of RRT they received, according to a recent 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 in PLoS Medicine (2014 Feb. 11 [doi:10.1371/journal.pmed.1001601]), come from POST-RENAL, an extended follow-up in a trial of 1,464 adult 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. Patients were treated in 35 centers in Australia or New Zealand between December 2005 and August 2008.

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% confidence interval, 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 significantly high rates of albuminuria: 40% and 44%, respectively (P = .48). Chronic proteinuria is an established risk factor for death, cardiovascular disease, and additional dialysis.

"Only one-third of randomized patients were alive 3.5 years later, a lower survival than that seen in recognized high mortality conditions such as the acute respiratory distress syndrome. Although, in our patients the risk of subsequent maintenance dialysis dependence is low, almost half have evidence of significant proteinuria, portending further risk in the years to come," Dr. Gallagher and his colleagues said in their analysis.

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," they wrote.

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.

Acute kidney injury survivors treated with renal replacement therapy in the ICU have high long-term mortality risk, regardless of the type of RRT they received, according to a recent 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 in PLoS Medicine (2014 Feb. 11 [doi:10.1371/journal.pmed.1001601]), come from POST-RENAL, an extended follow-up in a trial of 1,464 adult 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. Patients were treated in 35 centers in Australia or New Zealand between December 2005 and August 2008.

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% confidence interval, 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 significantly high rates of albuminuria: 40% and 44%, respectively (P = .48). Chronic proteinuria is an established risk factor for death, cardiovascular disease, and additional dialysis.

"Only one-third of randomized patients were alive 3.5 years later, a lower survival than that seen in recognized high mortality conditions such as the acute respiratory distress syndrome. Although, in our patients the risk of subsequent maintenance dialysis dependence is low, almost half have evidence of significant proteinuria, portending further risk in the years to come," Dr. Gallagher and his colleagues said in their analysis.

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," they wrote.

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.