To assess the incidence, risk factors and outcomes associated with acute kidney injury (AKI) in kidney transplant in-patients using RIFLE (R-risk, I-Injury, F-failure, L-loss, E-end stage) and AKIN (AKI network) classification.
A retrospective cohort analysis was performed on the data of all patients (with at least 3 months after transplantation) admitted to the hospital due to medical or surgical complications from 2007 to 2010.
Out of 712 patients, 458 were admitted to the hospital. The mean time from transplantation was 23±12 months; 55% were male and 60% were Caucasian. The mean age was 47±14 years; 62% received the graft from a deceased donor and the basal level creatinine was 1.53±0.63. The AKI incidence was 70 and 82% for RIFLE and AKIN criteria, respectively (agreement of 66%). Independent risk factors for AKI were infection (OR, 3.34; 95% CI, 1.11-10.04; P=0.032), use of iodinated contrast (OR, 9.58; 95% CI, 2.10-43.64; P=0.003), graft rejection (OR, 11.36; 95% CI, 2.65-48.65; P=0.001) and ICU hospitalization (OR, 9.70; CI, 1.97-47.74; P=0.005). Fifty-nine patients (13%) required dialysis. Rejection (OR, 6.67; 95% CI, 2.64-16.86; P<0.001) mechanical ventilation (OR, 16.46; 95% CI, 5.12-52.86; P<0.001), vasopressor use (OR, 7.50; 95% CI, 2.59-21.70; P<0.001) and high basal creatinine level (for each 1 mg/dl of creatinine increase, OR, 3.56; 95% CI, 2.12-5.97; P<0.001) were risk factors for need of dialysis therapy. Seventeen subjects (4%) were dialysis-dependent on hospital discharge. Ten patients died, all of them with AKI. Nine of these reached the stage F (RIFLE-F) or AKIN-3. Independent risk factors for mortality were coronary disease (OR, 8.91; 95% CI, 1.34-59.35; P=0.024) and sedative using (OR, 47.1; 95% CI, 4.09-54.48; P=0.002).
The AKI incidence is high in kidney transplant in-patients with acute illness when assessed by RIFLE and AKIN criteria. However, different from other scenarios of AKI, the mortality rate observed in renal transplant patients was lower.
To cite this abstract in AMA style:Filiponi T, Silva-Filho A, Requião-Moura L, Tonato E, Arruda E, Chinen R, Mello L, Bertocci A, Junior MDurão. Acute Kidney Injury in Kidney Transplant Patients According to the Rifle and Akin Criteria [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/acute-kidney-injury-in-kidney-transplant-patients-according-to-the-rifle-and-akin-criteria/. Accessed May 6, 2021.
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