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Title: Erythropoietin in traumatic brain injury associated acute kidney injury: A randomized controlled trial.
Austin Authors: 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 
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Departement d'anesthésie-réanimation, Hopital de la Cavale Blanche, Boulevard Tanguy Prigent, CHRU de Brest, Univeristé de Bretagne Occidental, Brest, France
King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
G&S Medical Associates, Urgent Care, Paterson, New Jersey
Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
St Vincent's University Hospital, Dublin, Ireland
Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
Department of Anaesthesia and Intensive Care, Hôpitaux universitaires Paris Sud (HUPS), Université Paris Sud XI, Orsay, France
Issue Date: 2019 2018-08-21
Publication information: Acta Anaesthesiologica Scandinavica 2019; 63(2): 200-207
Abstract: Acute kidney injury (AKI) in traumatic brain injury (TBI) is poorly understood and it is unknown if it can be attenuated using erythropoietin (EPO). Pre-planned analysis of patients included in the EPO-TBI ( 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. 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). 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.
DOI: 10.1111/aas.13244
ORCID: 0000-0001-8739-7896
PubMed URL: 30132785
Type: Journal Article
Subjects: acute kidney injury
critical care
renal insufficiency
traumatic brain injury
Appears in Collections:Journal articles

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