Erythropoietin in traumatic brain injury associated acute kidney injury

A randomized controlled trial

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1 Citation (Scopus)

Abstract

Background: Acute kidney injury (AKI) in traumatic brain injury (TBI) is poorly understood and it is unknown if it can be attenuated using erythropoietin (EPO). Methods: Pre-planned analysis of patients included in the EPO-TBI (ClinicalTrials.gov NCT00987454) trial who were randomized to weekly EPO (40 000 units) or placebo (0.9% sodium chloride) subcutaneously up to three doses or until intensive care unit (ICU) discharge. Creatinine levels and urinary output (up to 7 days) were categorized according to the Kidney Disease Improving Global Outcome (KDIGO) classification. Severity of TBI was categorized with the International Mission for Prognosis and Analysis of Clinical Trials in TBI. Results: Of 3348 screened patients, 606 were randomized and 603 were analyzed. Of these, 82 (14%) patients developed AKI according to KDIGO (60 [10%] with KDIGO 1, 11 [2%] patients with KDIGO 2, and 11 [2%] patients with KDIGO 3). Male gender (hazard ratio [HR] 4.0 95% confidence interval [CI] 1.4-11.2, P = 0.008) and severity of TBI (HR 1.3 95% CI 1.1-1.4, P < 0.001 for each 10% increase in risk of poor 6 month outcome) predicted time to AKI. KDIGO stage 1 (HR 8.8 95% CI 4.5-17, P < 0.001), KDIGO stage 2 (HR 13.2 95% CI 3.9-45.2, P < 0.001) and KDIGO stage 3 (HR 11.7 95% CI 3.5-39.7, P < 0.005) predicted time to mortality. EPO did not influence time to AKI (HR 1.08 95% CI 0.7-1.67, P = 0.73) or creatinine levels during ICU stay (P = 0.09). Conclusions: Acute kidney injury is more common in male patients and those with severe compared to moderate TBI and appears associated with worse outcome. EPO does not prevent AKI after TBI.

Original languageEnglish
Pages (from-to)200-207
Number of pages8
JournalActa Anaesthesiologica Scandinavica
Volume63
Issue number2
DOIs
Publication statusPublished - Feb 2019

Keywords

  • acute kidney injury
  • creatinine
  • critical care
  • erythropoietin
  • renal insufficiency
  • traumatic brain injury

Cite this

@article{b3de6b1750a747a399e0c91474e4417c,
title = "Erythropoietin in traumatic brain injury associated acute kidney injury: A randomized controlled trial",
abstract = "Background: Acute kidney injury (AKI) in traumatic brain injury (TBI) is poorly understood and it is unknown if it can be attenuated using erythropoietin (EPO). Methods: Pre-planned analysis of patients included in the EPO-TBI (ClinicalTrials.gov NCT00987454) trial who were randomized to weekly EPO (40 000 units) or placebo (0.9{\%} sodium chloride) subcutaneously up to three doses or until intensive care unit (ICU) discharge. Creatinine levels and urinary output (up to 7 days) were categorized according to the Kidney Disease Improving Global Outcome (KDIGO) classification. Severity of TBI was categorized with the International Mission for Prognosis and Analysis of Clinical Trials in TBI. Results: Of 3348 screened patients, 606 were randomized and 603 were analyzed. Of these, 82 (14{\%}) patients developed AKI according to KDIGO (60 [10{\%}] with KDIGO 1, 11 [2{\%}] patients with KDIGO 2, and 11 [2{\%}] patients with KDIGO 3). Male gender (hazard ratio [HR] 4.0 95{\%} confidence interval [CI] 1.4-11.2, P = 0.008) and severity of TBI (HR 1.3 95{\%} CI 1.1-1.4, P < 0.001 for each 10{\%} increase in risk of poor 6 month outcome) predicted time to AKI. KDIGO stage 1 (HR 8.8 95{\%} CI 4.5-17, P < 0.001), KDIGO stage 2 (HR 13.2 95{\%} CI 3.9-45.2, P < 0.001) and KDIGO stage 3 (HR 11.7 95{\%} CI 3.5-39.7, P < 0.005) predicted time to mortality. EPO did not influence time to AKI (HR 1.08 95{\%} CI 0.7-1.67, P = 0.73) or creatinine levels during ICU stay (P = 0.09). Conclusions: Acute kidney injury is more common in male patients and those with severe compared to moderate TBI and appears associated with worse outcome. EPO does not prevent AKI after TBI.",
keywords = "acute kidney injury, creatinine, critical care, erythropoietin, renal insufficiency, traumatic brain injury",
author = "Skrifvars, {Markus B.} and Elizabeth Moore and Johan M{\aa}rtensson and Michael Bailey and Craig French and Jeffrey Presneill and Alistair Nichol and Lorraine Little and Jacques Duranteau and Olivier Huet and Samir Haddad and Yaseen Arabi and Colin McArthur and Cooper, {David J.} and Rinaldo Bellomo and {The EPO-TBI Investigators and the ANZICS Clinical Trials Group}",
year = "2019",
month = "2",
doi = "10.1111/aas.13244",
language = "English",
volume = "63",
pages = "200--207",
journal = "Acta Anaesthesiologica Scandinavica",
issn = "0001-5172",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Erythropoietin in traumatic brain injury associated acute kidney injury

T2 - A randomized controlled trial

AU - Skrifvars, Markus B.

AU - Moore, Elizabeth

AU - Mårtensson, Johan

AU - Bailey, Michael

AU - French, Craig

AU - Presneill, Jeffrey

AU - Nichol, Alistair

AU - Little, Lorraine

AU - Duranteau, Jacques

AU - Huet, Olivier

AU - Haddad, Samir

AU - Arabi, Yaseen

AU - McArthur, Colin

AU - Cooper, David J.

AU - Bellomo, Rinaldo

AU - The EPO-TBI Investigators and the ANZICS Clinical Trials Group

PY - 2019/2

Y1 - 2019/2

N2 - Background: Acute kidney injury (AKI) in traumatic brain injury (TBI) is poorly understood and it is unknown if it can be attenuated using erythropoietin (EPO). Methods: Pre-planned analysis of patients included in the EPO-TBI (ClinicalTrials.gov NCT00987454) trial who were randomized to weekly EPO (40 000 units) or placebo (0.9% sodium chloride) subcutaneously up to three doses or until intensive care unit (ICU) discharge. Creatinine levels and urinary output (up to 7 days) were categorized according to the Kidney Disease Improving Global Outcome (KDIGO) classification. Severity of TBI was categorized with the International Mission for Prognosis and Analysis of Clinical Trials in TBI. Results: Of 3348 screened patients, 606 were randomized and 603 were analyzed. Of these, 82 (14%) patients developed AKI according to KDIGO (60 [10%] with KDIGO 1, 11 [2%] patients with KDIGO 2, and 11 [2%] patients with KDIGO 3). Male gender (hazard ratio [HR] 4.0 95% confidence interval [CI] 1.4-11.2, P = 0.008) and severity of TBI (HR 1.3 95% CI 1.1-1.4, P < 0.001 for each 10% increase in risk of poor 6 month outcome) predicted time to AKI. KDIGO stage 1 (HR 8.8 95% CI 4.5-17, P < 0.001), KDIGO stage 2 (HR 13.2 95% CI 3.9-45.2, P < 0.001) and KDIGO stage 3 (HR 11.7 95% CI 3.5-39.7, P < 0.005) predicted time to mortality. EPO did not influence time to AKI (HR 1.08 95% CI 0.7-1.67, P = 0.73) or creatinine levels during ICU stay (P = 0.09). Conclusions: Acute kidney injury is more common in male patients and those with severe compared to moderate TBI and appears associated with worse outcome. EPO does not prevent AKI after TBI.

AB - Background: Acute kidney injury (AKI) in traumatic brain injury (TBI) is poorly understood and it is unknown if it can be attenuated using erythropoietin (EPO). Methods: Pre-planned analysis of patients included in the EPO-TBI (ClinicalTrials.gov NCT00987454) trial who were randomized to weekly EPO (40 000 units) or placebo (0.9% sodium chloride) subcutaneously up to three doses or until intensive care unit (ICU) discharge. Creatinine levels and urinary output (up to 7 days) were categorized according to the Kidney Disease Improving Global Outcome (KDIGO) classification. Severity of TBI was categorized with the International Mission for Prognosis and Analysis of Clinical Trials in TBI. Results: Of 3348 screened patients, 606 were randomized and 603 were analyzed. Of these, 82 (14%) patients developed AKI according to KDIGO (60 [10%] with KDIGO 1, 11 [2%] patients with KDIGO 2, and 11 [2%] patients with KDIGO 3). Male gender (hazard ratio [HR] 4.0 95% confidence interval [CI] 1.4-11.2, P = 0.008) and severity of TBI (HR 1.3 95% CI 1.1-1.4, P < 0.001 for each 10% increase in risk of poor 6 month outcome) predicted time to AKI. KDIGO stage 1 (HR 8.8 95% CI 4.5-17, P < 0.001), KDIGO stage 2 (HR 13.2 95% CI 3.9-45.2, P < 0.001) and KDIGO stage 3 (HR 11.7 95% CI 3.5-39.7, P < 0.005) predicted time to mortality. EPO did not influence time to AKI (HR 1.08 95% CI 0.7-1.67, P = 0.73) or creatinine levels during ICU stay (P = 0.09). Conclusions: Acute kidney injury is more common in male patients and those with severe compared to moderate TBI and appears associated with worse outcome. EPO does not prevent AKI after TBI.

KW - acute kidney injury

KW - creatinine

KW - critical care

KW - erythropoietin

KW - renal insufficiency

KW - traumatic brain injury

UR - http://www.scopus.com/inward/record.url?scp=85052449838&partnerID=8YFLogxK

U2 - 10.1111/aas.13244

DO - 10.1111/aas.13244

M3 - Article

VL - 63

SP - 200

EP - 207

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 2

ER -