Temporal trends of dialysis requiring acute kidney injury after orthotopic cardiac and liver transplant hospitalizations

Abstract

BackgroundThe epidemiology and outcomes of acute kidney injury (AKI) in prevalent non-renal solid organ transplant recipients is unknown.MethodsWe assessed the epidemiology of trends in acute kidney injury (AKI) in orthotopic cardiac and liver transplant recipients in the United States. We used the Nationwide Inpatient Sample to evaluate the yearly incidence trends (2002 to 2013) of the primary outcome, defined as AKI requiring dialysis (AKI-D) in hospitalizations after cardiac and liver transplantation. We also evaluated the trend and impact of AKI-D on hospital mortality and adverse discharge using adjusted odds ratios (aOR).ResultsThe proportion of hospitalizations with AKI (9.7 to 32.7% in cardiac and 8.5 to 28.1% in liver transplant hospitalizations; ptrend<0.01) and AKI-D (1.63 to 2.33% in cardiac and 1.32 to 2.65% in liver transplant hospitalizations; ptrend<0.01) increased from 2002-2013. This increase in AKI-D was explained by changes in race and increase in age and comorbidity burden of transplant hospitalizations. AKI-D was associated with increased odds of in hospital mortality (aOR 2.85; 95% CI 2.11-3.80 in cardiac and aOR 2.00; 95% CI 1.55-2.59 in liver transplant hospitalizations) and adverse discharge [discharge other than home] (aOR 1.97; 95% CI 1.53-2.55 in cardiac and 1.91; 95% CI 1.57-2.30 in liver transplant hospitalizations).ConclusionsThis study highlights the growing burden of AKI-D in non-renal solid organ transplant recipients and its devastating impact, and emphasizes the need to develop strategies to reduce the risk of AKI to improve health outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0657-8) contains supplementary material, which is available to authorized users.

Predictors of renal replacement therapy after heart transplantation and its impact on long‐term survival

“…Given that in recent years the burden of CKD in patients with solid organ transplants has increased, and this is associated with high mortality, it is encouraging that patients who recover renal function after requiring RRT have an expectation of kidney function similar to other patients.…”

Acute Kidney Injury before Dialysis Initiation Predicts Adverse Outcomes in Hemodialysis Patients

“…Due to lack of clarity on the recovery status of AKI requiring dialysis, we restricted our definition to non-dialysis requiring AKI. It is well established and validated, however, that AKI codes lack sensitivity but have reasonable specificity [14, 15]. Thus, the frequency and impact of pre-ESRD AKI may be estimated conservatively.…”

“…Using ICD-9-CM codes 584.5, 584.6, 584.7, 584.8, and 584.9 for a diagnosis of AKI, we searched the Medicare inpatient claims for all eligible study participants. The specificity of this code-based method of establishing AKI has been validated in prior studies [14, 15]. During the acute hospitalization episodes, patients were required to have any of the considered AKI codes, and not be coded for an ESRD (ICD-9-CM code 585.6) concurrently.…”

New trends in the study of post-transplant acute kidney injury after liver transplantation

“…В одном из исследований было показано, что за период с 2002-го по 2013 год прослеживался рост количества пациентов после ТП с тяжелым ОПП, требующим проведения программного гемодиализа [12].…”

“…Острое повреждение почек после трансплантации непочечных солидных органов приводит к более длительному пребыванию в стационаре, более высокой стоимости лечения, к повышенному риску смерти, более частому развитию хронической болезни почек de novo [6,7]. Острое повреждение почек является распространенным и тяжелым осложнением также после трансплантации печени (ТП) [8][9][10][11][12]. Оно чаще наблюдается при использовании печени от асистолических доноров и обычно развивается в ранние сроки после ТП -от шести часов до конца первых суток после реперфузии [13].…”