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 journalArticlepeer-review

80 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 languageEnglish
Article numbere1001601
Pages (from-to)1-13
Number of pages13
JournalPLoS Medicine
Volume11
Issue number2
DOIs
Publication statusPublished - 1 Feb 2014
Externally publishedYes

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