(Press-News.org) In 4 years of follow up of 1464 participants in the randomized controlled trial Randomised Evaluation of Normal vs. Augmented Levels of RRT (RENAL) study, Martin Gallagher (The George Institute for Global Health, Sydney, Australia) and colleagues found that patients with acute kidney injury (AKI) in an intensive care unit (ICU) who require renal replacement therapy (RRT; hemodialysis combined with hemofiltration) do not benefit from higher intensity RRT. At a median of 43.9 months follow up, mortality (63% in the low intensity and 63% in the high intensity group), as well as quality of life among those who survived, were the same in both groups. Albuminuria (elevated protein levels in urine, signifying persistent kidney injury) was common among survivors and with equal rates in both groups (40% in the low intensity and 44% in the high intensity group).
The authors state, "Our study highlights the increased long-term risk of death associated with AKI treated with RRT in an ICU. Only one third of randomized patients were alive 3.5 years later, a lower survival than seen in recognised 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. These 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."
A limitation is that the patients were enrolled in a randomized trial and therefore not necessarily representative of patients in ICUs with AKI in general, and not all patients agreed to long term follow up.
The authors conclude, "In a large cohort of patients with acute kidney injury randomized to differing doses of continuous renal replacement therapy in the ICU, the increased risk of death continues well beyond hospital discharge and is not altered by increased intensity of dialysis. The proportion of patients entering a maintenance dialysis program is small but there is a high prevalence of proteinuria amongst survivors suggesting significant ongoing risk of chronic kidney disease and mortality."
INFORMATION:
Funding: This study was supported by an Australian Government NHMRC Project Grant (#632811). MG's work on this study was supported by a Jacquot Fellowship from the Royal Australasian College of Physicians. AC was supported by a NHMRC Senior Research Fellowship. JM is supported by a Practitioner Fellowship from the National Health and Medical Research Council. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: RB has received consulting fees from Gambro Pty Ltd. SF has received travel support to present research results at scientific meetings from Eli Lilly, Cardinal Health and CSL Bioplasma. The George Institute for Global Health, an independent not-for-profit institute affiliated with the University of Sydney, has received unrestricted grant support and travel expenses associated with a randomised-controlled trial of fluid resuscitation from Fresenius Kabi. It has also received reimbursement for SF's time as a steering committee member for studies sponsored by Eli Lilly and Eisai. The George Institute has received research funding from Servier, Novartis, Eisai, Merck, Sharp & Dohme, Pfizer Australia, Amgen, Fresenius Kabi Deutschland GmbH, and Sanofi Aventis.
Citation: Gallagher M, Cass A, Bellomo R, Finfer S, Gattas D, et al. (2014) Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care: Extended Follow-up of a Randomized Controlled Trial. PLoS Med 11(2): e1001601. doi:10.1371/journal.pmed.1001601
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001601
Contact:
Martin Gallagher
George Institute for Global Health
AUSTRALIA
+61 2 9993 4500
mgallagher@georgeinstitute.org.au
4 years on, ICU Patients with kidney injury show high mortality & elevated urinary protein
2014-02-12
ELSE PRESS RELEASES FROM THIS DATE:
Study challenges a close link between recent weight gain and diabetes
2014-02-12
It is a common notion that type 2 diabetes is precipitated by substantial progressive weight gain, but a study published this week in PLOS Medicine suggests that this might not be true.
Dorte Vistisen and Kristine Færch, from the Steno Diabetes Center in Gentofte, Denmark, and colleagues analyzed data from participants of the Whitehall II cohort, a group of London-based civil servants who have been followed for more than a decade, to see what changes in body weight and other parameters had occurred in people in the years before they were diagnosed with diabetes.
6,705 ...
What makes memories last?
2014-02-12
Prions can be notoriously destructive, spurring proteins to misfold and interfere with cellular function as they spread without control. New research, publishingin the open access journal PLOS Biology on February 11 2014, from scientists at the Stowers Institute for Medical Research reveals that certain prion-like proteins, however, can be precisely controlled so that they are generated only in a specific time and place. These prion-like proteins are not involved in disease processes; rather, they are essential for creating and maintaining long-term memories.
"This protein ...
Fifty-five genes linked to a powerful tumor suppressor predict breast cancer survival
2014-02-12
WASHINGTON — A panel of 55 genes, almost all of which are impacted by the loss of a particular protein, appears to predict if breast cancer will become invasive, leading to poorer survival, researchers at Georgetown Lombardi Comprehensive Cancer Center report in PLOS ONE.
The panel represents loss of a powerful tumor suppressor gene, SYK, as well as genetic alterations in 51 other genes that are directly affected by the loss of a copy of the SYK gene and the absence of its protein.
"Without SYK, the protein it makes, and genetic disruption in a set of genes thought ...
Kidney failure risk for organ donors 'extremely low'
2014-02-12
The risk of a kidney donor developing kidney failure in the remaining organ is much lower than in the population at large, even when compared with people who have two kidneys, according to results of new Johns Hopkins research.
The results, published in the Feb. 12 issue of the Journal of the American Medical Association, describes what is believed to be the largest study ever conducted of kidney disease risk in living kidney donors, encompassing all such donors in the United States over a 17-year period. The same researchers reporting in the same journal also showed ...
Study finds small increased risk of kidney disease following kidney donation
2014-02-12
An analysis of nearly 100,000 kidney donors finds that there is a small increased lifetime risk of developing end-stage renal disease following donation compared with healthy nondonors, although the risk is still much lower than that in the general population, according to a study in the February 12 issue of JAMA.
Every year in the United States, approximately 6,000 healthy adults accept the risks of kidney donation to help family members, friends, or even strangers. "It is imperative that the transplant community, in due diligence to donors, understands the risk of ...
Preterm infants more likely to have elevated insulin levels in early childhood
2014-02-12
Researchers have found that preterm infants are more likely to have elevated insulin levels at birth and in early childhood compared to full-term infants, findings that provide additional evidence that preterm birth may be a risk factor for type 2 diabetes, according to a study in the February 12 issue of JAMA.
In the United States, 1 in 9 live births are preterm, and l in 5 live births among African Americans are preterm. "There is growing evidence that fetal and early life events may result in permanent metabolic alterations, such as type 2 diabetes and metabolic syndrome ...
Fewer doses of HPV vaccine still results in reduced risk of STD
2014-02-12
Although maximum reduction in the risk of genital warts (condylomata) was seen after 3 doses of human papillomavirus (HPV) vaccine, receipt of 2 vaccine doses was associated with considerable reduction in risk, particularly among women who were younger than 17 years at first vaccination, according to a study in the February 12 issue of JAMA.
HPV infection causes genital warts and cervical cancer, and HPV vaccine prevents both. The typical dose schedule requires 3 doses of vaccine, but small clinical trials have reported measures of vaccine efficacy with fewer than 3 ...
Hospital readmission rate varies following care at rehabilitation facility
2014-02-12
Among rehabilitation facilities providing services to Medicare fee-for-service patients, 30-day hospital readmission rates vary, from about 6 percent for patients with lower extremity joint replacement to nearly 20 percent for patients with debility (weakness or feebleness), according to a study in the February 12 issue of JAMA.
The Centers for Medicare & Medicaid Services (CMS) recently identified 30-day hospital readmission as a national quality indicator for inpatient rehabilitation facilities; reporting will be required in 2014 by the CMS, according to background ...
Study examines legislative challenges to school immunization mandates
2014-02-12
From 2009-2012, 36 bills introduced in 18 states sought to modify school immunization mandates, with the majority seeking to expand exemptions although none of the bills passed, according to a study in the February 12 issue of JAMA.
"School immunization mandates, implemented through state-level legislation, have played an important role in maintaining high immunization coverage in the United States," according to background information in the article. Immunization mandates permit exemptions that vary from state to state in terms of type of exemption (e.g., religious, ...
Exercise may slow progression of retinal degeneration
2014-02-12
Washington, DC — Moderate aerobic exercise helps to preserve the structure and function of nerve cells in the retina after damage, according to an animal study appearing February 12 in The Journal of Neuroscience. The findings suggest exercise may be able to slow the progression of retinal degenerative diseases.
Age-related macular degeneration, one of the leading causes of blindness in the elderly, is caused by the death of light-sensing nerve cells in the retina called photoreceptors. Although several studies in animals and humans point to the protective effects ...