Gregory L Hundemer1,2, Anand Srivastava1,3, Kirolos A Jacob4, Neeraja Krishnasamudram1, Salman Ahmed1, Emily Boerger1, Shreyak Sharma1, Kapil K Pokharel1, Sameer A Hirji5, Marc Pelletier6, Kassem Safa7, Win Kulvichit8, John A Kellum8, Leonardo V Riella1, David E Leaf1. 1. Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 2. Division of Nephrology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. 3. Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 4. Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 5. Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 6. Division of Cardiac Surgery, University Hospitals, Case Western Reserve University, Cleveland, OH, USA. 7. Transplant Center and Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 8. Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA, USA.
Abstract
BACKGROUND: Acute kidney injury (AKI) is a key risk factor for chronic kidney disease in the general population, but has not been investigated in detail among renal transplant recipients (RTRs). We investigated the incidence, severity and risk factors for AKI following cardiac surgery among RTRs compared with non-RTRs with otherwise similar clinical characteristics. METHODS: We conducted a retrospective cohort study of RTRs (n = 83) and non-RTRs (n = 83) who underwent cardiac surgery at two major academic medical centers. Non-RTRs were matched 1:1 to RTRs by age, preoperative (preop) estimated glomerular filtration rate and type of cardiac surgery. We defined AKI according to Kidney Disease: Improving Global Outcomes criteria. RESULTS: RTRs had a higher rate of AKI following cardiac surgery compared with non-RTRs [46% versus 28%; adjusted odds ratio 2.77 (95% confidence interval 1.36-5.64)]. Among RTRs, deceased donor (DD) versus living donor (LD) status, as well as higher versus lower preop calcineurin inhibitor (CNI) trough levels, were associated with higher rates of AKI (57% versus 33% among DD-RTRs versus LD-RTRs; P = 0.047; 73% versus 36% among RTRs with higher versus lower CNI trough levels, P = 0.02). The combination of both risk factors (DD status and higher CNI trough level) had an additive effect (88% AKI incidence among patients with both risk factors versus 25% incidence among RTRs with neither risk factor, P = 0.004). CONCLUSIONS: RTRs have a higher risk of AKI following cardiac surgery compared with non-RTRs with otherwise similar characteristics. Among RTRs, DD-RTRs and those with higher preop CNI trough levels are at the highest risk.
BACKGROUND:Acute kidney injury (AKI) is a key risk factor for chronic kidney disease in the general population, but has not been investigated in detail among renal transplant recipients (RTRs). We investigated the incidence, severity and risk factors for AKI following cardiac surgery among RTRs compared with non-RTRs with otherwise similar clinical characteristics. METHODS: We conducted a retrospective cohort study of RTRs (n = 83) and non-RTRs (n = 83) who underwent cardiac surgery at two major academic medical centers. Non-RTRs were matched 1:1 to RTRs by age, preoperative (preop) estimated glomerular filtration rate and type of cardiac surgery. We defined AKI according to Kidney Disease: Improving Global Outcomes criteria. RESULTS: RTRs had a higher rate of AKI following cardiac surgery compared with non-RTRs [46% versus 28%; adjusted odds ratio 2.77 (95% confidence interval 1.36-5.64)]. Among RTRs, deceased donor (DD) versus living donor (LD) status, as well as higher versus lower preop calcineurin inhibitor (CNI) trough levels, were associated with higher rates of AKI (57% versus 33% among DD-RTRs versus LD-RTRs; P = 0.047; 73% versus 36% among RTRs with higher versus lower CNI trough levels, P = 0.02). The combination of both risk factors (DD status and higher CNI trough level) had an additive effect (88% AKI incidence among patients with both risk factors versus 25% incidence among RTRs with neither risk factor, P = 0.004). CONCLUSIONS: RTRs have a higher risk of AKI following cardiac surgery compared with non-RTRs with otherwise similar characteristics. Among RTRs, DD-RTRs and those with higher preop CNI trough levels are at the highest risk.
Authors: Chirag R Parikh; Steven G Coca; Heather Thiessen-Philbrook; Michael G Shlipak; Jay L Koyner; Zhu Wang; Charles L Edelstein; Prasad Devarajan; Uptal D Patel; Michael Zappitelli; Catherine D Krawczeski; Cary S Passik; Madhav Swaminathan; Amit X Garg Journal: J Am Soc Nephrol Date: 2011-08-11 Impact factor: 10.121
Authors: Henrik Ekberg; Helio Tedesco-Silva; Alper Demirbas; Stefan Vítko; Björn Nashan; Alp Gürkan; Raimund Margreiter; Christian Hugo; Josep M Grinyó; Ulrich Frei; Yves Vanrenterghem; Pierre Daloze; Philip F Halloran Journal: N Engl J Med Date: 2007-12-20 Impact factor: 91.245
Authors: Morgan E Grams; Sushrut S Waikar; Blaithin MacMahon; Seamus Whelton; Shoshana H Ballew; Josef Coresh Journal: Clin J Am Soc Nephrol Date: 2014-01-23 Impact factor: 8.237
Authors: Azra Bihorac; Lakhmir S Chawla; Andrew D Shaw; Ali Al-Khafaji; Danielle L Davison; George E Demuth; Robert Fitzgerald; Michelle Ng Gong; Derrel D Graham; Kyle Gunnerson; Michael Heung; Saeed Jortani; Eric Kleerup; Jay L Koyner; Kenneth Krell; Jennifer Letourneau; Matthew Lissauer; James Miner; H Bryant Nguyen; Luis M Ortega; Wesley H Self; Richard Sellman; Jing Shi; Joely Straseski; James E Szalados; Scott T Wilber; Michael G Walker; Jason Wilson; Richard Wunderink; Janice Zimmerman; John A Kellum Journal: Am J Respir Crit Care Med Date: 2014-04-15 Impact factor: 21.405