Acute Kidney Injury and Long-Term Risk for Cardiovascular Events in Patients after Kidney Transplantation

Abstract

Background: Acute kidney injury (AKI) was found to be associated with an increased risk of major adverse cardiovascular events (MACE) in the general population. Patients after kidney transplantation are prone to AKI events and are also at an increased risk of cardiovascular (CV) disease. The association between AKI and MACE in kidney transplant patients is yet to be studied. Methods: This retrospective single-center cohort study reviewed 416 adult renal allograft recipients transplanted between 2005 and 2010. AKI events were recorded starting 2 weeks after transplantation, or following discharge with a functioning graft. AKI was defined, according to the KDIGO criteria. The primary outcome was the composite of MACE starting 6 months after transplantation and all-cause mortality. For survival analysis, we used univariate and multivariate time varying Cox proportional hazard model. Results: One hundred and twenty-four patients (29.8%) had at least one episode of AKI. During the median follow-up time of 7.2 years (interquartile range 4.3–9.1), 144 outcome events occurred. By time varying Cox regression analysis, AKI was associated with an increased rate of CV outcomes or death (hazard ratio [HR] 1.96, 95% CI 1.36–2.81, p < 0.001), and the association remained significant by multivariate adjusted model (HR 1.76, 95% CI 1.18–2.63, p = 0.005). As for the different components of MACE, all-cause mortality and CV mortality were the only outcomes that were significantly associated with AKI. No interaction between AKI timing and MACE was found. Conclusion: AKI in kidney transplant recipient is associated with an increased risk of CV disease.

Minimizing Metabolic and Cardiac Risk Factors to Maximize Outcomes After Liver Transplantation

“…104 In retrospective studies of RTRs and LTRs from both living and deceased donors, acute kidney injury (AKI) was associated with increased rates of major adverse CV events, CV mortality, and all-cause mortality. 105,106 In a study of short-term MACE within 30 d of LT, hepatorenal syndrome was found to be an independent predictor for MACE. 107 Among hospitalized patients with AKI stratified by resultant renal recovery, those with complete recovery had a 23% risk reduction for long-term CV events.…”

Acute Kidney Injury in Kidney Transplant Patients in Intensive Care Unit: From Pathogenesis to Clinical Management

“…KTRs with AKI showed an increased risk of cardiovascular disease and mortality with respect to KTRs without AKI. A recent retrospective, single-center cohort study reported that AKI is associated with a 38% increased risk of major adverse cardiovascular events (MACE) and an 86% increased risk of cardiovascular mortality [129]. However, preexisting cardiovascular diseases before kidney transplantation may represent a risk factor for ICU admission and mortality rate among this population.…”

Management of the kidney transplant recipient in the intensive care unit

“…AKI progression to chronic kidney disease (CKD) in KTRs occurred in roughly half of ICU survivors at 6 months with hospital and 6-month mortality rates of 20% and 26.5%, respectively [8]. Independent of AKI, cardiovascular disease and development of donor-specific antibodies in the ICU may negatively impact graft survival [8,9]. De novo donor-specific antibody (DSA) can form after transfusions and reduction of immunosuppression.…”