INTRODUCTION AND AIMS: Acute kidney injury (AKI) is a frequent complication of critically ill patients in Intensive Care Units (ICUs) often associated with multiple organ failures and a high percentage of mortality. Despite the increased incidence of chronic kidney disease (CKD) in non renal solid organ transplant (NRSOT) recipients due to the nephrotoxicity of immunosuppressive drugs, only a few studies analyzed the clinical impact of AKI in this peculiar population. The aim of this study was a 10-year retrospective analysis (2001-2010) of AKI incidence in NRSOT recipients with the purpose to identify its impact on outcome and progression toward CKD. METHODS: We retrospectively analyzed all critically ill patients treated by renal replacement therapy (RRT) in ICUs in the period 2001-2010. For all patients RIFLE and SOFA scores and the severity index ATN_ISS were evaluated at the start of RRT. We then analyzed: 1) the percentage of NRSOT recipients in the whole population subjected to RRT; 2) the percentage of RRT-treated NRSOT patients in respect to the whole NRSOT population for single transplanted organ (liver, heart or lung). Patient outcome and renal function were evaluated at day 30 after the end of RRT treatment. Hemer-Lemeshow statistical test was performed. RESULTS: In the period 2001-2010 we treated by RRT (slow sustained hemofiltration of 10-12 hr duration, 0.6-1.3 m2 polysulphone membranes, 50% pre-dilution) 1833 AKI patients for a total of 9061 RRT sessions. AKI patients characteristics at RRT start were as follows: mean age 66.4±11.5 yrs, male 64.7%, mean serum creatinine 3.8±1.9 mg%, mean number of organ failures 3,4±1,38, mean ATN_ISS score 0,738±0,192. Of interest, we found that in the whole AKI population, 233 (12.7%) were NRSOT recipients. Indeed, we treated by RRT 151/1335 (11,3 %) patients with a liver graft, 60/229 (26,2 %) with a heart graft and 22/88 (25%) with a lung graft. The prevalent cause of AKI in NRSOT patients was sepsis (43.6%), a condition associated with an increased incidence of mortality and with a difficult management of the immunosuppressive therapy. The global mortality rate in RRT-treated NRSOT patients was 45.49% (106/233), 43.5% (66/151) for liver, 51.6% (31/60) for heart and 40.9% (9/22) for lung graft recipients. Moreover, in the survivor group, the mean serum creatinine values at the end of the observational period was 2.34±0.78 mg%. CONCLUSIONS: Our retrospective 10-year analysis of critically ill patients treated by RRT in ICUs revealed an increased incidence of AKI in the NRSOT population. Sepsis was the main cause of AKI in NSROT recipients. AKI was associated with an increase of mortality and with an impairment of renal function that required a close and highly skilled nephrologic follow-up.
RETROSPECTIVE ANALYSIS OF ACUTE KIDNEY INJURY (AKI) IN NON RENAL SOLID ORGAN TRANSPLANT RECIPIENTS: INCIDENCE, OUTCOME AND IMPACT ON RESIDUAL RENAL FUNCTION
CANTALUPPI, Vincenzo;GIACALONE, SYLVIA;TAMAGNONE, MICHELA;BASSO, ELISA;GAI, Massimo;SEGOLONI, Giuseppe
2011-01-01
Abstract
INTRODUCTION AND AIMS: Acute kidney injury (AKI) is a frequent complication of critically ill patients in Intensive Care Units (ICUs) often associated with multiple organ failures and a high percentage of mortality. Despite the increased incidence of chronic kidney disease (CKD) in non renal solid organ transplant (NRSOT) recipients due to the nephrotoxicity of immunosuppressive drugs, only a few studies analyzed the clinical impact of AKI in this peculiar population. The aim of this study was a 10-year retrospective analysis (2001-2010) of AKI incidence in NRSOT recipients with the purpose to identify its impact on outcome and progression toward CKD. METHODS: We retrospectively analyzed all critically ill patients treated by renal replacement therapy (RRT) in ICUs in the period 2001-2010. For all patients RIFLE and SOFA scores and the severity index ATN_ISS were evaluated at the start of RRT. We then analyzed: 1) the percentage of NRSOT recipients in the whole population subjected to RRT; 2) the percentage of RRT-treated NRSOT patients in respect to the whole NRSOT population for single transplanted organ (liver, heart or lung). Patient outcome and renal function were evaluated at day 30 after the end of RRT treatment. Hemer-Lemeshow statistical test was performed. RESULTS: In the period 2001-2010 we treated by RRT (slow sustained hemofiltration of 10-12 hr duration, 0.6-1.3 m2 polysulphone membranes, 50% pre-dilution) 1833 AKI patients for a total of 9061 RRT sessions. AKI patients characteristics at RRT start were as follows: mean age 66.4±11.5 yrs, male 64.7%, mean serum creatinine 3.8±1.9 mg%, mean number of organ failures 3,4±1,38, mean ATN_ISS score 0,738±0,192. Of interest, we found that in the whole AKI population, 233 (12.7%) were NRSOT recipients. Indeed, we treated by RRT 151/1335 (11,3 %) patients with a liver graft, 60/229 (26,2 %) with a heart graft and 22/88 (25%) with a lung graft. The prevalent cause of AKI in NRSOT patients was sepsis (43.6%), a condition associated with an increased incidence of mortality and with a difficult management of the immunosuppressive therapy. The global mortality rate in RRT-treated NRSOT patients was 45.49% (106/233), 43.5% (66/151) for liver, 51.6% (31/60) for heart and 40.9% (9/22) for lung graft recipients. Moreover, in the survivor group, the mean serum creatinine values at the end of the observational period was 2.34±0.78 mg%. CONCLUSIONS: Our retrospective 10-year analysis of critically ill patients treated by RRT in ICUs revealed an increased incidence of AKI in the NRSOT population. Sepsis was the main cause of AKI in NSROT recipients. AKI was associated with an increase of mortality and with an impairment of renal function that required a close and highly skilled nephrologic follow-up.
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