Research 11 July 2023

Optimising recovery for patients with acute kidney injury

Intensive Care Consultant, Professor Sameer Patel is researching the effects of three different anticoagulants on patients with liver disease who require continuous renal replacement therapy for acute kidney injury. Our grant will help determine which drug performs the best, thus avoiding bleeding complications and ensuring faster recovery for patients.

Liver patients have a severely altered coagulation status that puts them at an increased risk of either excessive bleeding or clotting. At King’s, approximately 50% of patients with chronic liver disease who require hospitalisation go on to develop acute kidney injury (AKI), which requires continuous renal replacement therapy (CRRT). This translates into approximately 350 patients per year at King's alone, and about 1,000 patients across the UK.

For patients with AKI, blood thinning or anticoagulant medication is required to allow kidney dialysis machines to work without the blood clotting. Commonly used anticoagulation drugs include heparin, prostacyclin and, more recently, citrate. Each one acts differently on the clotting pathway and may have variable effects. As yet, because no one has compared the efficacy and safety of these medications against each other in patients with liver failure, the best choice of drug remains uncertain.

However, thanks to our funding, Professor Patel and his team of specialists are now performing a randomised control trial comparing these three anticoagulants in critically ill liver failure patients who require CRRT for AKI. The results of the trial will reduce complications like bleeding, improve recovery times and lead to a reduction in mortality. Understanding the role of these medications and whether one is superior to another will not only benefit patients at King's but also inform best practice nationally and internationally.