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Early intervention with erythropoietin does not affect the outcome of acute kidney injury (the EARLYARF trial)

Endre, Zoltan H., Walker, Robert J., Pickering, John W., Shaw, Geoffrey M., Frampton, Christopher, Henderson, Seton J., Hutchison, Robyn, Mehrtens, Jan E., Robinson, Jillian M., Schollum, John B. W., Westhuyzen, Justin, Celi, Leo A., McGinley, Robert J., Campbell, Isaac J. and George, Peter M. 2010, Early intervention with erythropoietin does not affect the outcome of acute kidney injury (the EARLYARF trial), Kidney international, vol. 77, no. 11, pp. 1020-1030, doi: 10.1038/ki.2010.25.

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Title Early intervention with erythropoietin does not affect the outcome of acute kidney injury (the EARLYARF trial)
Author(s) Endre, Zoltan H.
Walker, Robert J.
Pickering, John W.
Shaw, Geoffrey M.
Frampton, Christopher
Henderson, Seton J.
Hutchison, Robyn
Mehrtens, Jan E.
Robinson, Jillian M.
Schollum, John B. W.
Westhuyzen, Justin
Celi, Leo A.
McGinley, Robert J.ORCID iD for McGinley, Robert J. orcid.org/0000-0003-2329-0779
Campbell, Isaac J.
George, Peter M.
Journal name Kidney international
Volume number 77
Issue number 11
Start page 1020
End page 1030
Publisher Nature Publishing Group
Place of publication London, Eng.
Publication date 2010-06
ISSN 0085-2538
1523-1755
Keyword(s) acute renal failure
clinical trial
erythropoietin
randomized controlled trials
Summary We performed a double-blind placebo-controlled trial to study whether early treatment with erythropoietin could prevent the development of acute kidney injury in patients in two general intensive care units. As a guide for choosing the patients for treatment we measured urinary levels of two biomarkers, the proximal tubular brush border enzymes γ-glutamyl transpeptidase and alkaline phosphatase. Randomization to either placebo or two doses of erythropoietin was triggered by an increase in the biomarker concentration product to levels above 46.3, with a primary outcome of relative average plasma creatinine increase from baseline over 4 to 7 days. Of 529 patients, 162 were randomized within an average of 3.5 h of a positive sample. There was no difference in the incidence of erythropoietin-specific adverse events or in the primary outcome between the placebo and treatment groups. The triggering biomarker concentration product selected patients with more severe illness and at greater risk of acute kidney injury, dialysis, or death; however, the marker elevations were transient. Early intervention with high-dose erythropoietin was safe but did not alter the outcome. Although these two urine biomarkers facilitated our early intervention, their transient increase compromised effective triaging. Further, our study showed that a composite of these two biomarkers was insufficient for risk stratification in a patient population with a heterogeneous onset of injury.
Language eng
DOI 10.1038/ki.2010.25
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2010, Nature Publishing Group
Persistent URL http://hdl.handle.net/10536/DRO/DU:30043860

Document type: Journal Article
Collection: School of Medicine
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