Predictors of Need of Renal Replacement Therapy among Lung Transplant Patients Admitted to the Medical Intensive Care Unit

Abstract

Purpose Increasing number of patients are undergoing lung transplantation (LT) every year and many of these patients have episodes of decompensation requiring admission to medical intensive care unit (MICU). We sought to identify baseline variables that predict need of renal replacement therapy (RRT) among these patients. Methods and Materials This study was part of an ongoing registry study among all the patients admitted to MICU (a 53 bedded closed unit) at the Cleveland Clinic. Between July 2011-2012, 101 patients with LT were admitted to the MICU. Among these, 10 were on chronic hemodialysis and were excluded (n=91, age 55.3±12.9 years, M:F50:41). Data regarding baseline clinical and laboratory variables, need of RRT, length of stay in ICU and hospital survival was analysed. Study group was divided into patients who needed RRT versus those who did not and variables were compared between the two groups. Results Significant number of patients needed some form of RRT (n=22, 24.2%). Renal functions at admission to MICU did not predict need of RRT. On univariate analysis, patients who needed RRT were more likely to be diabetic (59.1% vs 27.5%, OR 3.8, 1.4-10.3, P=0.007), have history of cystic fibrosis (CF) (81.8%vs18.8% for non CF, P 74 (Adjusted OR 25.7,1.3-487.5, P=0.031) were the independent predictors of need of RRT. Conclusions A significant number of patients with LT admitted to MICU need RRT and this is associated with a worse outcome. History of cystic fibrosis and diabetes and APACHE III score >74 are independent predictors of need of RRT.