Prognosis of acute kidney injury requiring renal replacement therapy in solid organ transplanted patients.
Solid organ transplanted patients represent a complex and multi-morbid population with potential acute illness. They are at high risk not only for chronic renal failure (CRF), but also for acute kidney injury (AKI) and little is known about the overall epidemiology or prognosis. We conducted a retrospective review of all solid organ transplant patients who required emergency renal replacement therapy (RRT) for AKI during a period of 7.5 years. We identified 53 episodes of AKI requiring RRT occurring in 51 transplanted patients, and 58.5% of them were freshly (<48 h) transplanted when admitted in ICU. The majority of episodes were a result of cardio-circulatory or septic events (84%), and a large proportion of the AKI episodes were a result of multifactorial causes (27%). Overall 90 days mortality was 49%, and no difference was detected between kidney and nonkidney transplants. On univariate analysis, the risk factors for death were smoking status [OR = 4.09 (CI 95%: 1.16-14.43); P = 0.028] and sepsis [OR = 4.90 (CI 95%: 1.39-17.31); P = 0.014]. Transplanted patients with AKI are younger, more prone to be diabetic and to have previous chronic renal failure compared with the general ICU population, possibly in part because of their immunosuppressive therapy. Nevertheless, they have the same prognosis.
Charbonney
Emmanuel
E
Critical Care Department, St Michael's Hospital, Toronto, ON, Canada. charbonneye@smh.toronto.on.ca
Saudan
Patrick
P
Triverio
Pierre-Alain
PA
Quinn
Kieran
K
Mentha
Gilles
G
Martin
Pierre-Yves
PY
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004630:Emergencies / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D012907:Smoking / Q000453:epidemiology; D013557:Switzerland / Q000453:epidemiology
D007166:Immunosuppressive Agents