Effects of Baseline Thrombocytopenia and Platelet Decrease Following Renal Replacement Therapy Initiation in Patients With Severe Acute Kidney Injury

Objectives: Thrombocytopenia is common in critically ill patients with severe acute kidney injury and may be worsened by the use of renal replacement therapy. In this study, we evaluate the effects of renal replacement therapy on subsequent platelet values, the prognostic significance of a decrease in platelets, and potential risk factors for platelet decreases. Design: Post hoc analysis of the Acute Renal Failure Trial Network Study. Setting: The Acute Renal Failure Trial Network study was a multicenter, prospective, randomized, parallel-group trial of two strategies for renal replacement therapy in critically ill patients with acute kidney injury conducted between November 2003 and July 2007 at 27 Veterans Affairs and university-affiliated medical centers. Subjects: The Acute Renal Failure Trial Network study evaluated 1,124 patients with severe acute kidney injury requiring renal replacement therapy. Interventions: Predictor variables were thrombocytopenia at initiation of renal replacement therapy and platelet decrease following renal replacement therapy initiation. Measurements and Main Results: Outcomes were mortality at 28 days, 60 days, and 1 year, renal recovery, renal replacement therapy free days, ICU-free days, and hospital-free days. Baseline thrombocytopenia in patients requiring renal replacement therapy was associated with increased mortality and was also associated with lower rates of renal recovery. A decrease in platelet values following renal replacement therapy initiation was associated with increased mortality. Continuous renal replacement therapy was not an independent predictor of worsening thrombocytopenia compared with those treated with intermittent hemodialysis. Conclusions: Baseline thrombocytopenia and platelet decrease following renal replacement therapy initiation were associated with increased mortality, and baseline thrombocytopenia was associated with decreased rates of renal recovery. Continuous renal replacement therapy did not decrease platelets compared with hemodialysis. The analyses presented in this article were not prepared in conjunction with the Acute Renal Failure Trial Network (ATN) Study investigators and do not represent the opinions or views of the ATN study, the Veterans Affairs, or the National Institute of Diabetes and Digestive and Kidney Diseases. Drs. Griffin, Jovanovich, Palevsky, Faubel, Jalal contributed to research idea and study design and data analysis/interpretation. Dr. Griffin contributed to data acquisition. Dr. You contributed to statistical analysis. Drs. Jovanovich, Palevsky, Faubel, Jalal contributed to supervision or mentorship. Each author contributed important intellectual content during article drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://bit.ly/29S62lw). The Department of Veterans Affairs (VA)/National Institutes of Health Acute Renal Failure Trial Network study was supported, in part, by the Cooperative Studies Program (CSP) of the VA Office of Research and Development as CSP number 530 and by the National Institute of Diabetes and Digestive and Kidney Diseases under interagency agreement Y1-DK-3508-01. Dr. Griffin's institution received funding from National Kidney Foundation, and he received funding from the Nephrology Young Investigators Meeting (travel). Dr. Griffin is supported by a National Research Service Award Institutional Predoctoral Training Grant (T32), grant number T32 DK 007135. Dr. Jovanovich's institution received funding from Veterans Affairs, and she disclosed government work. Dr. Jovanovich is supported by Veterans Affairs CDA 5IK2CX001030-04. Drs. Palevsky and Jalal received support for article research from the National Institutes of Health. Dr. Palevsky also received support for article research from the United States Department of Veterans Affairs. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: benjamin.griffin@ucdenver.edu Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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