Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation

Janet M Boyle; Soundous Moualla; Susana Arrigain; Sarah Worley; Mohamed H Bakri; Randall C Starling; Robert Heyka; Charuhas V Thakar

doi:10.1053/j.ajkd.2006.08.002

Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation

Janet M Boyle, Soundous Moualla, Susana Arrigain, Sarah Worley, Mohamed H Bakri, Randall C Starling, Robert Heyka, Charuhas V Thakar^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

110 Citations (Scopus)

Abstract

BACKGROUND: Risk factors for postoperative acute kidney injury (AKI) are well described in nontransplantation settings. Data regarding risks and consequences of AKI after cardiac transplantation are unclear.

METHODS: We analyzed 756 cardiac transplant recipients between 1993 and 2004. The primary outcome is postoperative AKI requiring dialysis therapy. Secondary outcomes are hospital mortality and postoperative morbidities, including cardiac, neurological, and serious infection. Wilcoxon rank-sum, chi-square, or Fisher exact tests were used for univariable comparison. A bootstrap-bagging procedure (1,000 repetitions) and multivariable logistic analysis with multiple imputation were used for the final model.

RESULTS: AKI frequency was 5.8% (44 of 756 patients). By means of univariable analysis, preoperative risk factors for AKI were diabetes, prior cardiac surgery, intra-aortic balloon pump use, albumin level, creatinine level, clinical severity score, and cold ischemia time. Intraoperative risk factors were cardiopulmonary bypass time and transfusion requirement. By means of multivariate analysis, serum creatinine level (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.6 to 4.6), serum albumin level (OR, 0.34; 95% CI, 0.21 to 0.54), insulin-requiring diabetes (OR, 3.5; 95% CI, 1.4 to 9.0), and cardiopulmonary bypass time (OR, 1.29; 95% CI, 1.02 to 1.64) were independent predictors of postoperative AKI. The overall postoperative mortality rate was 4.2%; it was 50% in patients with AKI compared with 1.4% in patients without AKI. AKI was associated with greater frequencies of cardiac, neurological, and serious infection morbidities (43.2%, 18.2%, and 54.6% versus 5.5%, 2.3%, and 7.2%, respectively; P < 0.001).

CONCLUSION: AKI is associated with significant morbidity and mortality after cardiac transplantation. Predictors of AKI can be used to risk-stratify patients to ameliorate further kidney injury and offer a survival benefit.

Original language	English
Pages (from-to)	787-796
Number of pages	10
Journal	American Journal of Kidney Diseases
Volume	48
Issue number	5
DOIs	https://doi.org/10.1053/j.ajkd.2006.08.002
Publication status	Published - 01 Nov 2006
Externally published	Yes

Keywords

Acute Kidney Injury/epidemiology
Adult
Cardiopulmonary Bypass
Cerebrovascular Disorders/epidemiology
Creatinine/blood
Diabetes Mellitus/epidemiology
Dialysis
Female
Heart Failure/epidemiology
Heart Transplantation/adverse effects
Hospital Mortality
Humans
Length of Stay
Logistic Models
Male
Morbidity
Multivariate Analysis
Myocardial Infarction/epidemiology
Peripheral Vascular Diseases/epidemiology
Postoperative Complications/epidemiology
Pulmonary Disease, Chronic Obstructive/epidemiology
ROC Curve
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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@article{b4b2bce952fa4a47a76ed94c25a49a34,

title = "Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation",

abstract = "BACKGROUND: Risk factors for postoperative acute kidney injury (AKI) are well described in nontransplantation settings. Data regarding risks and consequences of AKI after cardiac transplantation are unclear.METHODS: We analyzed 756 cardiac transplant recipients between 1993 and 2004. The primary outcome is postoperative AKI requiring dialysis therapy. Secondary outcomes are hospital mortality and postoperative morbidities, including cardiac, neurological, and serious infection. Wilcoxon rank-sum, chi-square, or Fisher exact tests were used for univariable comparison. A bootstrap-bagging procedure (1,000 repetitions) and multivariable logistic analysis with multiple imputation were used for the final model.RESULTS: AKI frequency was 5.8% (44 of 756 patients). By means of univariable analysis, preoperative risk factors for AKI were diabetes, prior cardiac surgery, intra-aortic balloon pump use, albumin level, creatinine level, clinical severity score, and cold ischemia time. Intraoperative risk factors were cardiopulmonary bypass time and transfusion requirement. By means of multivariate analysis, serum creatinine level (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.6 to 4.6), serum albumin level (OR, 0.34; 95% CI, 0.21 to 0.54), insulin-requiring diabetes (OR, 3.5; 95% CI, 1.4 to 9.0), and cardiopulmonary bypass time (OR, 1.29; 95% CI, 1.02 to 1.64) were independent predictors of postoperative AKI. The overall postoperative mortality rate was 4.2%; it was 50% in patients with AKI compared with 1.4% in patients without AKI. AKI was associated with greater frequencies of cardiac, neurological, and serious infection morbidities (43.2%, 18.2%, and 54.6% versus 5.5%, 2.3%, and 7.2%, respectively; P < 0.001).CONCLUSION: AKI is associated with significant morbidity and mortality after cardiac transplantation. Predictors of AKI can be used to risk-stratify patients to ameliorate further kidney injury and offer a survival benefit.",

keywords = "Acute Kidney Injury/epidemiology, Adult, Cardiopulmonary Bypass, Cerebrovascular Disorders/epidemiology, Creatinine/blood, Diabetes Mellitus/epidemiology, Dialysis, Female, Heart Failure/epidemiology, Heart Transplantation/adverse effects, Hospital Mortality, Humans, Length of Stay, Logistic Models, Male, Morbidity, Multivariate Analysis, Myocardial Infarction/epidemiology, Peripheral Vascular Diseases/epidemiology, Postoperative Complications/epidemiology, Pulmonary Disease, Chronic Obstructive/epidemiology, ROC Curve, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors",

author = "Boyle, {Janet M} and Soundous Moualla and Susana Arrigain and Sarah Worley and Bakri, {Mohamed H} and Starling, {Randall C} and Robert Heyka and Thakar, {Charuhas V}",

year = "2006",

month = nov,

day = "1",

doi = "10.1053/j.ajkd.2006.08.002",

language = "English",

volume = "48",

pages = "787--796",

journal = "American Journal of Kidney Diseases",

issn = "0272-6386",

publisher = "W.B. Saunders",

number = "5",

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TY - JOUR

T1 - Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation

AU - Boyle, Janet M

AU - Moualla, Soundous

AU - Arrigain, Susana

AU - Worley, Sarah

AU - Bakri, Mohamed H

AU - Starling, Randall C

AU - Heyka, Robert

AU - Thakar, Charuhas V

PY - 2006/11/1

Y1 - 2006/11/1

N2 - BACKGROUND: Risk factors for postoperative acute kidney injury (AKI) are well described in nontransplantation settings. Data regarding risks and consequences of AKI after cardiac transplantation are unclear.METHODS: We analyzed 756 cardiac transplant recipients between 1993 and 2004. The primary outcome is postoperative AKI requiring dialysis therapy. Secondary outcomes are hospital mortality and postoperative morbidities, including cardiac, neurological, and serious infection. Wilcoxon rank-sum, chi-square, or Fisher exact tests were used for univariable comparison. A bootstrap-bagging procedure (1,000 repetitions) and multivariable logistic analysis with multiple imputation were used for the final model.RESULTS: AKI frequency was 5.8% (44 of 756 patients). By means of univariable analysis, preoperative risk factors for AKI were diabetes, prior cardiac surgery, intra-aortic balloon pump use, albumin level, creatinine level, clinical severity score, and cold ischemia time. Intraoperative risk factors were cardiopulmonary bypass time and transfusion requirement. By means of multivariate analysis, serum creatinine level (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.6 to 4.6), serum albumin level (OR, 0.34; 95% CI, 0.21 to 0.54), insulin-requiring diabetes (OR, 3.5; 95% CI, 1.4 to 9.0), and cardiopulmonary bypass time (OR, 1.29; 95% CI, 1.02 to 1.64) were independent predictors of postoperative AKI. The overall postoperative mortality rate was 4.2%; it was 50% in patients with AKI compared with 1.4% in patients without AKI. AKI was associated with greater frequencies of cardiac, neurological, and serious infection morbidities (43.2%, 18.2%, and 54.6% versus 5.5%, 2.3%, and 7.2%, respectively; P < 0.001).CONCLUSION: AKI is associated with significant morbidity and mortality after cardiac transplantation. Predictors of AKI can be used to risk-stratify patients to ameliorate further kidney injury and offer a survival benefit.

AB - BACKGROUND: Risk factors for postoperative acute kidney injury (AKI) are well described in nontransplantation settings. Data regarding risks and consequences of AKI after cardiac transplantation are unclear.METHODS: We analyzed 756 cardiac transplant recipients between 1993 and 2004. The primary outcome is postoperative AKI requiring dialysis therapy. Secondary outcomes are hospital mortality and postoperative morbidities, including cardiac, neurological, and serious infection. Wilcoxon rank-sum, chi-square, or Fisher exact tests were used for univariable comparison. A bootstrap-bagging procedure (1,000 repetitions) and multivariable logistic analysis with multiple imputation were used for the final model.RESULTS: AKI frequency was 5.8% (44 of 756 patients). By means of univariable analysis, preoperative risk factors for AKI were diabetes, prior cardiac surgery, intra-aortic balloon pump use, albumin level, creatinine level, clinical severity score, and cold ischemia time. Intraoperative risk factors were cardiopulmonary bypass time and transfusion requirement. By means of multivariate analysis, serum creatinine level (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.6 to 4.6), serum albumin level (OR, 0.34; 95% CI, 0.21 to 0.54), insulin-requiring diabetes (OR, 3.5; 95% CI, 1.4 to 9.0), and cardiopulmonary bypass time (OR, 1.29; 95% CI, 1.02 to 1.64) were independent predictors of postoperative AKI. The overall postoperative mortality rate was 4.2%; it was 50% in patients with AKI compared with 1.4% in patients without AKI. AKI was associated with greater frequencies of cardiac, neurological, and serious infection morbidities (43.2%, 18.2%, and 54.6% versus 5.5%, 2.3%, and 7.2%, respectively; P < 0.001).CONCLUSION: AKI is associated with significant morbidity and mortality after cardiac transplantation. Predictors of AKI can be used to risk-stratify patients to ameliorate further kidney injury and offer a survival benefit.

KW - Acute Kidney Injury/epidemiology

KW - Adult

KW - Cardiopulmonary Bypass

KW - Cerebrovascular Disorders/epidemiology

KW - Creatinine/blood

KW - Diabetes Mellitus/epidemiology

KW - Dialysis

KW - Female

KW - Heart Failure/epidemiology

KW - Heart Transplantation/adverse effects

KW - Hospital Mortality

KW - Humans

KW - Length of Stay

KW - Logistic Models

KW - Male

KW - Morbidity

KW - Multivariate Analysis

KW - Myocardial Infarction/epidemiology

KW - Peripheral Vascular Diseases/epidemiology

KW - Postoperative Complications/epidemiology

KW - Pulmonary Disease, Chronic Obstructive/epidemiology

KW - ROC Curve

KW - Retrospective Studies

KW - Risk Assessment

KW - Risk Factors

KW - Time Factors

U2 - 10.1053/j.ajkd.2006.08.002

DO - 10.1053/j.ajkd.2006.08.002

M3 - Article

C2 - 17059998

SN - 0272-6386

VL - 48

SP - 787

EP - 796

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

IS - 5

ER -

Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation

Abstract

Keywords

UN SDGs

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