The impact of red blood cells storage duration on the development of acute kidney injury: A secondary analysis of the TRANSFUSE multicenter randomized controlled trial

Abstract

Red blood cell (RBC) transfusion is associated with an increased risk of acute kidney injury (AKI). The extent to which RBC storage affects this association is unclear. We aimed to evaluate the association between storage duration and the occurrence or worsening of any degree of AKI in critically ill patients. In this pre-planned sub-study of the Standard Issue Transfusion versus Fresher Red-Cell Use in Intensive Care (TRANSFUSE) trial, which compared mortality of critically ill patients receiving either the freshest available allogenic RBC unit or standard availability RBC, patients hospitalized in one of the 31 participating sites and who did not have Stage 3 AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) classification were eligible. The primary outcome was the cumulative proportion of patients who developed any degree of new AKI. A total of 899 patients were included. The mean (SD) RBC storage duration was 22.4 (7.4) versus 11.9 (5.4) days in the standard issue RBC and short-storage RBC groups, respectively (p < 0.01). The percentage of patients who developed any stage of new AKI was similar between groups (24.8% in the standard issue RBC group versus 26.1% in the short-storage RBC group; p = 0.66) (Relative Risk 0.95, [95% confidence intervals 0.76-1.19]). There was no difference in secondary outcomes. In this pre-planned sub-study of the TRANSFUSE trial, compared with using standard issue RBC, the transfusion of the freshest available RBC was not associated with a decrease in AKI.