Association between transient acute kidney injury and morbidity and mortality after lung transplantation: a retrospective cohort study

Pedro Fidalgo; Mohammed Ahmed; Steven R Meyer; Dale Lien; Justin Weinkauf; Ali Kapasi; Filipe S Cardoso; Kathy Jackson; Sean M Bagshaw

doi:10.1016/j.jcrc.2014.07.024

Association between transient acute kidney injury and morbidity and mortality after lung transplantation: a retrospective cohort study

J Crit Care. 2014 Dec;29(6):1028-34. doi: 10.1016/j.jcrc.2014.07.024. Epub 2014 Jul 31.

Authors

Pedro Fidalgo¹, Mohammed Ahmed², Steven R Meyer³, Dale Lien⁴, Justin Weinkauf⁵, Ali Kapasi⁶, Filipe S Cardoso⁷, Kathy Jackson⁸, Sean M Bagshaw⁹

Affiliations

¹ Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, Edmonton, Alberta, Canada; Nephrology Department, Hospital Prof Dr Fernando Fonseca, Amadora, Portugal. Electronic address: [email protected].
² Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, Edmonton, Alberta, Canada. Electronic address: [email protected].
³ Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. Electronic address: [email protected].
⁴ Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: [email protected].
⁵ Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: [email protected].
⁶ Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: [email protected].
⁷ Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, Edmonton, Alberta, Canada; Gastroenterology Department, Hospital Prof Dr Fernando Fonseca, Amadora, Portugal. Electronic address: [email protected].
⁸ Lung Transplant Program, Alberta Health Services, Edmonton, Alberta, Canada. Electronic address: [email protected].
⁹ Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, Edmonton, Alberta, Canada. Electronic address: [email protected].

PMID: 25138690
DOI: 10.1016/j.jcrc.2014.07.024

Abstract

Purpose: Acute kidney injury (AKI) is a common occurrence after lung transplantation (LTx). Whether transient AKI or early recovery is associated with improved outcome is uncertain. Our aim was to describe the incidence, factors, and outcomes associated with transient AKI after LTx.

Materials and methods: We performed a retrospective cohort study of all adult recipients of LTx at the University of Alberta between 1990 and 2011. Our primary outcome transient AKI was defined as return of serum creatinine below Kidney Disease-Improving Global Outcome AKI stage I within 7days after LTx. Secondary outcomes included occurrence of postoperative complications, mortality, and long-term kidney function.

Results: Of 445 LTx patients enrolled, AKI occurred in 306 (68.8%) within the first week after LTx. Of these, transient AKI (or early recovery) occurred in 157 (51.3%). Transient AKI was associated with fewer complications including tracheostomy (17.2% vs 38.3%; P<.001), reintubation (16.4% vs 41.9%; P<.001), decreased duration of mechanical ventilation (median [interquartile range], 69 [41-142] vs 189 [63-403] hours; P<.001), and lower rates of chronic kidney disease at 3 months (28.5% vs 51.1%, P<.001) and 1 year (49.6% vs 66.7%, P=.01) compared with persistent AKI. Factors independently associated with persistent AKI were higher body mass index (per unit; odds ratio [OR], 0.91; 95% confidence interval, 0.85-0.98; P=.01), cyclosporine use (OR, 0.29; 0.12-0.67; P=.01), longer duration of mechanical ventilation (per hour [log transformed]; OR, 0.42; 0.21-0.81; P=.01), and AKI stages II to III (OR, 0.16; 0.08-0.29; P<.001). Persistent AKI was associated with higher adjusted hazard of death (hazard ratio, 1.77 [1.08-2.93]; P=.02) when compared with transient AKI (1.44 [0.93-2.19], P=.09) and no AKI (reference category), respectively.

Conclusions: Transient AKI after LTx is associated with fewer complications and improved survival. Among survivors, persistent AKI portends an increased risk for long-term chronic kidney disease.

Keywords: Acute kidney injury; Chronic kidney disease; Lung transplantation; Mortality; Recovery; Transient AKI.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Kidney Injury / blood
Acute Kidney Injury / epidemiology*
Acute Kidney Injury / etiology
Acute Kidney Injury / mortality
Adult
Age Factors
Creatinine / blood
Female
Humans
Incidence
Kidney Function Tests
Lung Transplantation / adverse effects*
Lung Transplantation / mortality
Male
Middle Aged
Morbidity
Odds Ratio
Postoperative Complications / etiology
Renal Insufficiency, Chronic / epidemiology
Renal Insufficiency, Chronic / etiology
Respiration, Artificial / statistics & numerical data
Retrospective Studies
Risk Factors
Time Factors
Tracheostomy / statistics & numerical data

Substances

Creatinine