Incidence and Treatment of Arginine Vasopressin Deficiency (Central Diabetes Insipidus) in the Setting of Brain Death and Associations with Renal Function and Hemodynamics in Organ Donors

Abstract

Background/Objectives: Arginine vasopressin deficiency (AVP-D) is a common condition in the setting of brain death. The aim of this study was to analyze the frequency of AVP-D in organ donors, its treatment, as well as the impact of AVP-D on hemodynamics and renal function. Methods: This single-center, retrospective study included 63 organ donors treated between 2017 and 2022. We used standard criteria to examine the incidence of AVP-D and the KDIGO criteria to determine the rate of acute kidney injury (AKI). Results: AVP-D occurred in 79% of the examined organ donors, of which 94% received desmopressin. Overall, 30% of organ donors developed AKI. AKI was present in 77% of donors who did not meet AVP-D criteria and in only 18% of donors with AVP-D (p < 0.001). Mean arterial blood pressure did not differ between organ donors with and without AVP-D or with and without desmopressin therapy. In organ donors with AVP-D, norepinephrine requirement in the period 24 h prior to AVP-D diagnosis was lower than 24 h afterwards (p = 0.03). AVP-D diagnosis was associated with a higher rate of kidney transplantation compared to cases without AVP-D diagnosis (88% vs. 54%, p = 0.01). Conclusions: AVP-D is common among brain death organ donors and may remain undiagnosed in cases with previous kidney injury. These observations highlight the importance of recognizing AVP-D and administering appropriate therapy in potential organ donors to prevent AKI.