Kidney study may save critically ill patients' lives

Researchers from the Christchurch Kidney Research Group of the University of Otago, Christchurch, have recently finished the world’s largest study into how to earlier detect the often fatal condition of acute kidney disease in critically ill patients.

The study could allow intensive care unit (ICU) specialists to intervene earlier with appropriate treatment and save more lives.

A key paper from the study has just been published in a leading international kidney-related publication, Nephrology Dialysis Transplantation.

It showed a new blood test given to South Island ICU patients detected potentially life-threatening kidney injuries earlier and more reliably than the current screening test.

Lead investigator Professor Zoltan Endre from Otago University’s Christchurch School of Medicine & Health Sciences says the study holds great potential for revolutionising the way patients with kidney injury are treated.

“Eventually practise in intensive care will be changed because of these studies.’’

“All over the world they are seeking early indicators of kidney injury. The earlier it is picked up the better the likelihood of survival.’’

Professor Endre is one of the world’s leaders in research and treatment of AKI.

He says the incidence of acute kidney injury (AKI) is increasing worldwide, especially in ICUs. In his research involving ICU patients about 45 per cent of subjects had the condition – or more than 3000 New Zealanders a year.

Mortality rates in the ICU for patients with AKI range from 20 per cent to 47 per cent.

Many patients arrive in intensive care after accidents or heart attacks and often have multiple injuries, including AKI, Prof Endre says.

This study involved 444 patients who entered the Christchurch or Dunedin intensive care units.

Patients’ blood was tested on admission to the units and then for the following seven days.

The blood was screened for the presence of cystatin C.

Analysis by PhD student Dr Maryam Nejat, found screening with the new cystatin C test, patients’ potentially life-threatening kidney injuries were detected earlier than by the current screening tool, creatinine, in 66 per cent of the cases.

Professor Endre says the rate of death from AKI has not really improved over the past 50 years so this study provides a real advantage to clinicians.

The cystatin C test is inexpensive and, after more tests to prove its effectiveness, will no doubt become regularly used in hospitals, he says.

The cystatin C study is part of a larger research project into the early detection and treatment of kidney problems.

The study was funded by the Health Research Council of New Zealand and the University of Otago. The paper “Rapid detection of acute kidney injury by plasma cystatin C in the intensive care unit” was authored by Maryam Nejat, John Pickering, Rob Walker, and Zoltan Endre. Dr Nejat is a recipient of a University of Otago PhD scholarship.