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PRBC Transfusion in Lung Injury Patients Associated With Acute Kidney Injury Requiring Dialysis
Michael D. O'Neill
November 6, 2007 (San Francisco) — Transfusion of packed red blood cells (PRBCs) in patients with acute lung injury is associated with an increased incidence of acute kidney injury (AKI) requiring dialysis, according to a new study. This suggests that the association between transfusion and dialysis-requiring AKI needs to be further explored in critically ill patients.
The study was presented here at Renal Week 2007, the American Society of Nephrology Annual Meeting, by Kathleen Liu, MD, PhD, assistant adjunct professor, Department of Medicine, Nephrology, and Critical Care Medicine, at the University of California, San Francisco.
The study was undertaken because although transfusion appears to be a risk factor for AKI in the setting of coronary artery bypass surgery, the effect of transfusion on the subsequent development of AKI in other critically ill populations remains unknown.
"The concern overall with transfusions is that we have always thought of transfusions as something with benefit and little risk. It is becoming increasingly clear that transfusions are associated with a number of risks, including an increased risk of mortality and an increased risk of other end-organ failure," Dr. Liu said.
"The debate in the kidney world had really been limited to the setting of bypass surgery. So this is one of the first studies to look at a more general population and to suggest [that] transfusion in that setting may also be associated with an increased risk of kidney injury," Dr. Liu added.
In the study, the researchers investigated the association of transfusion of PRBCs and the development of AKI in patients from the Acute Respiratory Distress Syndrome Network Fluid and Catheter Treatment Trial. Study subjects were patients with acute lung injury defined by the American-European Consensus Criteria. Of eligible participants (N = 979), dialysis was initiated in 112 (11%) within the first 28 days of the study; 345 (35%) received a PRBC transfusion.
Transfusion of PRBCs was associated with a hazard ratio (HR) for dialysis-requiring AKI of 3.74 (95% confidence interval [CI], 2.52 – 5.58). After adjustment for age, sex, race, APACHE III score, time at risk, baseline creatinine and hemoglobin levels, treatment allocation, and systolic blood pressure before transfusion, transfusion of PRBCs remained associated with the development of dialysis-requiring AKI (HR, 2.15; 95% CI, 1.38 – 3.37;
P = .001).
Norbert Lameire, MD, PhD, one of the session moderators, noted that "it was a pretty much convincing study, but you cannot be sure that in the 2 groups...the comorbidity or underlying disease or the general health of these patients was not different. So before you conclude this is harmful, you should be absolutely sure why there was a need for the transfusion in 1 group and not the other." Dr. Lameire is professor of medicine at the University Hospital-Ghent in Belgium.
This study was supported by funding from the National Heart Lung and Blood Institute and the National Center for Research Resources. Collaborating institutions included the University of California, San Francisco; the University of Virginia; and Massachusetts General Hospital.
Renal Week 2007: Abstract SA-FC029. Presented November 3, 2007.
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