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Type: Journal article
Title: Long-term survival and dialysis dependency following acute kidney injury in intensive care: extended follow-up of a randomized controlled trial
Author: Gallagher, M.
Cass, A.
Bellomo, R.
Finfer, S.
Gattas, D.
Lee, J.
Lo, S.
McGuinness, S.
Myburgh, J.
Parke, R.
Rajbhandari, D.
Citation: PLoS Medicine, 2014; 11(2):e1001601
Publisher: Public Library of Science
Issue Date: 2014
ISSN: 1549-1676
Statement of
Martin Gallagher, Alan Cass, Rinaldo Bellomo, Simon Finfer, David Gattas, Joanne Lee, Serigne Lo, Shay McGuinness, John Myburgh, Rachael Parke, Dorrilyn Rajbhandari, for the POSTRENAL Study Investigators and the ANZICS Clinical Trials Group
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: www.ClinicalTrials.govNCT00221013.
Keywords: POST-RENAL Study Investigators and the ANZICS Clinical Trials Group; Humans; Albuminuria; Treatment Outcome; Renal Dialysis; Prevalence; Multivariate Analysis; Proportional Hazards Models; Odds Ratio; Risk Factors; Chi-Square Distribution; Prospective Studies; Time Factors; Aged; Middle Aged; Survivors; Intensive Care Units; Australia; New Zealand; Female; Male; Kaplan-Meier Estimate; Acute Kidney Injury
Description: Participating investigator: Athanasios Flabouris for the University of Adelaide
Rights: © 2014 Gallagher et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
RMID: 0030015617
DOI: 10.1371/journal.pmed.1001601
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