title: Impact of acute kidney injury on renal allograft survival.
abstract: BACKGROUND
  Acute kidney injury (AKI) is one of the major determinants of graft survival in kidney transplantation (KTx). Renal Transplant recipients are more vulnerable to develop AKI than general population. AKI in the transplant recipient differs from community acquired, in terms of risk factors, etiology and outcome. Our aim was to study the incidence, risk factors, etiology, outcome and the impact of AKI on graft survival.
  
  
  METHODS
  A retrospective analysis of 219 renal transplant recipients (both live and deceased donor) was done.
  
  
  RESULTS
  AKI was observed in 112 (51.14%) recipients, with mean age of 41.5 ± 11.2 years during follow-up of 43.2 ± 12.5 months. Etiologies of AKI were infection (47.32%), rejection (26.78%), calcineurin inhibitor (CNI) toxicity (13.39%), and recurrence of native kidney disease (NKD) (4.46%). New Onset Diabetes After Transplant (NODAT) and deceased donor transplant were the significant risk factors for AKI. During follow-up 70.53% (p = .004) of AKI recipients progressed to chronic kidney disease (CKD) in contrast to only 11.21% (p = .342) of non AKI recipients. Risk factors for CKD were AKI within first year of transplant (HR: 7.32, 95%CI: 4.37-15.32, p = .007), multiple episodes of AKI (HR: 6.92, 95%CI: 3.92-9.63, p = .008), infection (HR: 3.62, 95%CI: 2.8-5.75, p = .03) and rejection (HR: 9.92 95%CI: 5.56-12.36, p = .001).
  
  
  CONCLUSIONS
  Renal transplant recipients have high risk for AKI and it hampers long-term graft survival.
authors: a Department of Nephrology , Madras Medical College & Rajiv Gandhi Government General Hospital , Chennai , Tamil Nadu , India.
authors: Mani
authors: M
authors: Nagarajan
authors: a Department of Nephrology , Madras Medical College & Rajiv Gandhi Government General Hospital , Chennai , Tamil Nadu , India.
authors: Sakthirajan
authors: S
authors: Ramanathan
authors: a Department of Nephrology , Madras Medical College & Rajiv Gandhi Government General Hospital , Chennai , Tamil Nadu , India.
authors: Jeyachandran
authors: J
authors: Dhanapriya
authors: a Department of Nephrology , Madras Medical College & Rajiv Gandhi Government General Hospital , Chennai , Tamil Nadu , India.
authors: Thanigachalam
authors: T
authors: Dineshkumar
authors: a Department of Nephrology , Madras Medical College & Rajiv Gandhi Government General Hospital , Chennai , Tamil Nadu , India.
authors: T Bala
authors: TB
authors: Subramaniyan
authors: a Department of Nephrology , Madras Medical College & Rajiv Gandhi Government General Hospital , Chennai , Tamil Nadu , India.
authors: Natarajan
authors: N
authors: Gopalakrishnan
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000328:Adult; D003404:Creatinine / Q000097:blood*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D014184:Transplantation, Homologous
chemical_list: D003404:Creatinine
keywords: AKI; CKD; graft survival; hemodialysis; kidney transplant