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; Imogen Mitchell; Elise Taylor; Rachel Whyte; Asif Raza; Kiran Nand; Treena Sara; David Millis; Helen Wong; Peter Harrigan; Miranda Hardie; Diana Whitaker; Deepak Bhonagiri; Sharon Micallef; Katrina Ellem; Melissa Lintott; Louise Cole; Cheryl Cuzner; Leonie Weisbrodt; Sarah Whereat; Yahya Shehabi; Frances Bass; Pam Edhouse; Marisa Jenkins; Simon Finfer; Simon Bird; Anne O'Connor; Richard Totaro; Liarna Honeysett; Dorrilyn Rajbhandari; Deborah Inskip; Rebecca Sidoli; Priya Nair; Claire Reynolds; Ashoke Banerjee; Jing Kong; Christina Skelly; Shay McGuinness; Jodi Brown; Eileen Gilder; Rachael Parke; Colin McArthur; Lynette Newby; Catherine Simmonds; Seton Henderson; Jan Mehrtens; Duncan Sugden; Michael Kalkoff; Kim McGregor; Catherine Shaw; John Morgan; Kylie Gregory; Joanne Sutton; Peter Garrett; Anny Buckley; Shona McDonald; Chris Joyce; Meg Harward; Georgina Sexton; Kelly Perkins; Jeff Lipman; Rachel Dunlop; Melissa Lassig-Smith; Therese Starr; Arthas Flabouris; Stephanie O'Connor; Justine Rivett; Andrew Turner; Rick McAllister; Victoria Trubody; Glenn Eastwood; Leah Peck; Jason Fletcher; Benno Ihle; Samuel Ho; Joey Micallef; Lynne Murray; John Botha; Sharon Allsop; Jodi Vuat; Claire Cattigan; Tania Elderkin; Craig Walker; Pauline Galt; Ainsley Gillies; Nerina Harley; Deborah Barge; Tania Caf; Andrea Jordon; John Santamaria; Jennifer Holmes; Roger Smith; Carlos Scheinkestel; Helen Donaldson; Shirley Vallance; Craig French; Samantha Bates; Jenie Butler; Frank Breheny; Anna Palermo; Geoff Dobb; Jenny Chamberlain; Penny Lord; Min Jun; Alexia Yianni; Sabine D'Haeseleer

doi: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

Martin Gallagher^*, Alan Cass, Rinaldo Bellomo, Simon Finfer, David Gattas, Joanne Lee, Serigne Lo, Shay McGuinness, John Myburgh, Rachael Parke, Dorrilyn Rajbhandari, Imogen Mitchell, Elise Taylor, Rachel Whyte, Asif Raza, Kiran Nand, Treena Sara, David Millis, Helen Wong, Peter HarriganMiranda Hardie, Diana Whitaker, Deepak Bhonagiri, Sharon Micallef, Katrina Ellem, Melissa Lintott, Louise Cole, Cheryl Cuzner, Leonie Weisbrodt, Sarah Whereat, Yahya Shehabi, Frances Bass, Pam Edhouse, Marisa Jenkins, Simon Finfer, Simon Bird, Anne O'Connor, Richard Totaro, Liarna Honeysett, Dorrilyn Rajbhandari, Deborah Inskip, Rebecca Sidoli, Priya Nair, Claire Reynolds, Ashoke Banerjee, Jing Kong, Christina Skelly, Shay McGuinness, Jodi Brown, Eileen Gilder, Rachael Parke, Colin McArthur, Lynette Newby, Catherine Simmonds, Seton Henderson, Jan Mehrtens, Duncan Sugden, Michael Kalkoff, Kim McGregor, Catherine Shaw, John Morgan, Kylie Gregory, Joanne Sutton, Peter Garrett, Anny Buckley, Shona McDonald, Chris Joyce, Meg Harward, Georgina Sexton, Kelly Perkins, Jeff Lipman, Rachel Dunlop, Melissa Lassig-Smith, Therese Starr, Arthas Flabouris, Stephanie O'Connor, Justine Rivett, Andrew Turner, Rick McAllister, Victoria Trubody, Glenn Eastwood, Leah Peck, Jason Fletcher, Benno Ihle, Samuel Ho, Joey Micallef, Lynne Murray, John Botha, Sharon Allsop, Jodi Vuat, Claire Cattigan, Tania Elderkin, Craig Walker, Pauline Galt, Ainsley Gillies, Nerina Harley, Deborah Barge, Tania Caf, Andrea Jordon, John Santamaria, Jennifer Holmes, Roger Smith, Carlos Scheinkestel, Helen Donaldson, Shirley Vallance, Craig French, Samantha Bates, Jenie Butler, Frank Breheny, Anna Palermo, Geoff Dobb, Jenny Chamberlain, Penny Lord, Min Jun, Alexia Yianni, Sabine D'Haeseleer

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

118 Citations (Scopus)

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.Trial registration:http://www.ClinicalTrials.gov NCT00221013 Please see later in the article for the Editors' Summary.

Original language	English
Article number	e1001601
Pages (from-to)	1-13
Number of pages	13
Journal	PLoS Medicine
Volume	11
Issue number	2
DOIs	https://doi.org/10.1371/journal.pmed.1001601
Publication status	Published - 1 Feb 2014
Externally published	Yes

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10.1371/journal.pmed.1001601

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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., Mitchell, I., Taylor, E., Whyte, R., Raza, A., Nand, K., Sara, T., Millis, D., Wong, H., ... D'Haeseleer, S. (2014). Long-term survival and dialysis dependency following acute kidney injury in intensive care: extended follow-up of a randomized controlled trial. PLoS Medicine, 11(2), 1-13. Article e1001601. https://doi.org/10.1371/journal.pmed.1001601

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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.Trial registration:http://www.ClinicalTrials.gov NCT00221013 Please see later in the article for the Editors' Summary.",

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 and Imogen Mitchell and Elise Taylor and Rachel Whyte and Asif Raza and Kiran Nand and Treena Sara and David Millis and Helen Wong and Peter Harrigan and Miranda Hardie and Diana Whitaker and Deepak Bhonagiri and Sharon Micallef and Katrina Ellem and Melissa Lintott and Louise Cole and Cheryl Cuzner and Leonie Weisbrodt and Sarah Whereat and Yahya Shehabi and Frances Bass and Pam Edhouse and Marisa Jenkins and Simon Finfer and Simon Bird and Anne O'Connor and Richard Totaro and Liarna Honeysett and Dorrilyn Rajbhandari and Deborah Inskip and Rebecca Sidoli and Priya Nair and Claire Reynolds and Ashoke Banerjee and Jing Kong and Christina Skelly and Shay McGuinness and Jodi Brown and Eileen Gilder and Rachael Parke and Colin McArthur and Lynette Newby and Catherine Simmonds and Seton Henderson and Jan Mehrtens and Duncan Sugden and Michael Kalkoff and Kim McGregor and Catherine Shaw and John Morgan and Kylie Gregory and Joanne Sutton and Peter Garrett and Anny Buckley and Shona McDonald and Chris Joyce and Meg Harward and Georgina Sexton and Kelly Perkins and Jeff Lipman and Rachel Dunlop and Melissa Lassig-Smith and Therese Starr and Arthas Flabouris and Stephanie O'Connor and Justine Rivett and Andrew Turner and Rick McAllister and Victoria Trubody and Glenn Eastwood and Leah Peck and Jason Fletcher and Benno Ihle and Samuel Ho and Joey Micallef and Lynne Murray and John Botha and Sharon Allsop and Jodi Vuat and Claire Cattigan and Tania Elderkin and Craig Walker and Pauline Galt and Ainsley Gillies and Nerina Harley and Deborah Barge and Tania Caf and Andrea Jordon and John Santamaria and Jennifer Holmes and Roger Smith and Carlos Scheinkestel and Helen Donaldson and Shirley Vallance and Craig French and Samantha Bates and Jenie Butler and Frank Breheny and Anna Palermo and Geoff Dobb and Jenny Chamberlain and Penny Lord and Min Jun and Alexia Yianni and Sabine D'Haeseleer",

year = "2014",

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language = "English",

volume = "11",

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journal = "PLoS Medicine",

issn = "1549-1277",

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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, Mitchell, I, Taylor, E, Whyte, R, Raza, A, Nand, K, Sara, T, Millis, D, Wong, H, Harrigan, P, Hardie, M, Whitaker, D, Bhonagiri, D, Micallef, S, Ellem, K, Lintott, M, Cole, L, Cuzner, C, Weisbrodt, L, Whereat, S, Shehabi, Y, Bass, F, Edhouse, P, Jenkins, M, Finfer, S, Bird, S, O'Connor, A, Totaro, R, Honeysett, L, Rajbhandari, D, Inskip, D, Sidoli, R, Nair, P, Reynolds, C, Banerjee, A, Kong, J, Skelly, C, McGuinness, S, Brown, J, Gilder, E, Parke, R, McArthur, C, Newby, L, Simmonds, C, Henderson, S, Mehrtens, J, Sugden, D, Kalkoff, M, McGregor, K, Shaw, C, Morgan, J, Gregory, K, Sutton, J, Garrett, P, Buckley, A, McDonald, S, Joyce, C, Harward, M, Sexton, G, Perkins, K, Lipman, J, Dunlop, R, Lassig-Smith, M, Starr, T, Flabouris, A, O'Connor, S, Rivett, J, Turner, A, McAllister, R, Trubody, V, Eastwood, G, Peck, L, Fletcher, J, Ihle, B, Ho, S, Micallef, J, Murray, L, Botha, J, Allsop, S, Vuat, J, Cattigan, C, Elderkin, T, Walker, C, Galt, P, Gillies, A, Harley, N, Barge, D, Caf, T, Jordon, A, Santamaria, J, Holmes, J, Smith, R, Scheinkestel, C, Donaldson, H, Vallance, S, French, C, Bates, S, Butler, J, Breheny, F, Palermo, A, Dobb, G, Chamberlain, J, Lord, P, Jun, M, Yianni, A & D'Haeseleer, S 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

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

AU - Mitchell, Imogen

AU - Taylor, Elise

AU - Whyte, Rachel

AU - Raza, Asif

AU - Nand, Kiran

AU - Sara, Treena

AU - Millis, David

AU - Wong, Helen

AU - Harrigan, Peter

AU - Hardie, Miranda

AU - Whitaker, Diana

AU - Bhonagiri, Deepak

AU - Micallef, Sharon

AU - Ellem, Katrina

AU - Lintott, Melissa

AU - Cole, Louise

AU - Cuzner, Cheryl

AU - Weisbrodt, Leonie

AU - Whereat, Sarah

AU - Shehabi, Yahya

AU - Bass, Frances

AU - Edhouse, Pam

AU - Jenkins, Marisa

AU - Finfer, Simon

AU - Bird, Simon

AU - O'Connor, Anne

AU - Totaro, Richard

AU - Honeysett, Liarna

AU - Rajbhandari, Dorrilyn

AU - Inskip, Deborah

AU - Sidoli, Rebecca

AU - Nair, Priya

AU - Reynolds, Claire

AU - Banerjee, Ashoke

AU - Kong, Jing

AU - Skelly, Christina

AU - McGuinness, Shay

AU - Brown, Jodi

AU - Gilder, Eileen

AU - Parke, Rachael

AU - McArthur, Colin

AU - Newby, Lynette

AU - Simmonds, Catherine

AU - Henderson, Seton

AU - Mehrtens, Jan

AU - Sugden, Duncan

AU - Kalkoff, Michael

AU - McGregor, Kim

AU - Shaw, Catherine

AU - Morgan, John

AU - Gregory, Kylie

AU - Sutton, Joanne

AU - Garrett, Peter

AU - Buckley, Anny

AU - McDonald, Shona

AU - Joyce, Chris

AU - Harward, Meg

AU - Sexton, Georgina

AU - Perkins, Kelly

AU - Lipman, Jeff

AU - Dunlop, Rachel

AU - Lassig-Smith, Melissa

AU - Starr, Therese

AU - Flabouris, Arthas

AU - O'Connor, Stephanie

AU - Rivett, Justine

AU - Turner, Andrew

AU - McAllister, Rick

AU - Trubody, Victoria

AU - Eastwood, Glenn

AU - Peck, Leah

AU - Fletcher, Jason

AU - Ihle, Benno

AU - Ho, Samuel

AU - Micallef, Joey

AU - Murray, Lynne

AU - Botha, John

AU - Allsop, Sharon

AU - Vuat, Jodi

AU - Cattigan, Claire

AU - Elderkin, Tania

AU - Walker, Craig

AU - Galt, Pauline

AU - Gillies, Ainsley

AU - Harley, Nerina

AU - Barge, Deborah

AU - Caf, Tania

AU - Jordon, Andrea

AU - Santamaria, John

AU - Holmes, Jennifer

AU - Smith, Roger

AU - Scheinkestel, Carlos

AU - Donaldson, Helen

AU - Vallance, Shirley

AU - French, Craig

AU - Bates, Samantha

AU - Butler, Jenie

AU - Breheny, Frank

AU - Palermo, Anna

AU - Dobb, Geoff

AU - Chamberlain, Jenny

AU - Lord, Penny

AU - Jun, Min

AU - Yianni, Alexia

AU - D'Haeseleer, Sabine

PY - 2014/2/1

Y1 - 2014/2/1

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.Trial registration:http://www.ClinicalTrials.gov NCT00221013 Please see later in the article for the Editors' Summary.

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.Trial registration:http://www.ClinicalTrials.gov NCT00221013 Please see later in the article for the Editors' Summary.

UR - http://www.scopus.com/inward/record.url?scp=84895469553&partnerID=8YFLogxK

U2 - 10.1371/journal.pmed.1001601

DO - 10.1371/journal.pmed.1001601

M3 - Article

C2 - 24523666

AN - SCOPUS:84895469553

SN - 1549-1277

VL - 11

SP - 1

EP - 13

JO - PLoS Medicine

JF - PLoS Medicine

IS - 2

M1 - e1001601

ER -

Long-term survival and dialysis dependency following acute kidney injury in intensive care: extended follow-up of a randomized controlled trial

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