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Erythropoietin in traumatic brain injury associated acute kidney injury: A randomized controlled trial
Author(s) -
Skrifvars Markus B.,
Moore Elizabeth,
Mårtensson Johan,
Bailey Michael,
French Craig,
Presneill Jeffrey,
Nichol Alistair,
Little Lorraine,
Duranteau Jacques,
Huet Olivier,
Haddad Samir,
Arabi Yaseen,
McArthur Colin,
Cooper David J.,
Bellomo Rinaldo
Publication year - 2019
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13244
Subject(s) - medicine , acute kidney injury , hazard ratio , traumatic brain injury , kidney disease , erythropoietin , randomized controlled trial , confidence interval , intensive care unit , creatinine , psychiatry
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 .