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Randomized Controlled Trial
. 2025 May;65(5):876-885.
doi: 10.1111/trf.18230. Epub 2025 Mar 29.

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

Cécile Aubron  1   2 , Elizabeth M Moore  3 , Bridget Ady  2 , Eldho Paul  2 , Maija Kaukonen  2 , Lynne Murray  2 , Jonathan Barrett  4 , Matthew Bailey  5 , Timothy Bowles  6 , Sean Kelly  7 , Claire Cattigan  8 , David Cooper  9 , David Ernest  10 , David Evans  11 , Jason Fletcher  12 , Craig French  13 , David Gattas  14 , Dhaval Ghelani  15 , Seton Henderson  16 , Alex Kazemi  17 , Bruce King  18 , Peter Kruger  19 , Janet Liang  20 , Christopher MacIsaac  21 , Colin McArthur  22 , Alistair Nichol  23 , Sandra Peake  24 , Michael C Reade  25 , Brent Richards  26 , John Santamaria  27 , Paul Young  28 , Michael Bailey  2 , Rinaldo Bellomo  29 , D James Cooper  2   30 , Zoe K McQuilten  3
Affiliations
Randomized Controlled Trial

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

Cécile Aubron et al. Transfusion. 2025 May.

Abstract

Background: 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.

Study design and methods: 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.

Results: 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.

Discussion: 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.

Keywords: acute kidney injury; critically ill patients; red blood cell; storage lesion; transfusion.

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References

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