Abstract
BackgroundThe epidemiology and outcomes of acute kidney injury (AKI) in prevalent non-renal solid organ transplant recipients is unknown.MethodsWe assessed the epidemiology of trends in acute kidney injury (AKI) in orthotopic cardiac and liver transplant recipients in the United States. We used the Nationwide Inpatient Sample to evaluate the yearly incidence trends (2002 to 2013) of the primary outcome, defined as AKI requiring dialysis (AKI-D) in hospitalizations after cardiac and liver transplantation. We also evaluated the trend and impact of AKI-D on hospital mortality and adverse discharge using adjusted odds ratios (aOR).ResultsThe proportion of hospitalizations with AKI (9.7 to 32.7% in cardiac and 8.5 to 28.1% in liver transplant hospitalizations; ptrend<0.01) and AKI-D (1.63 to 2.33% in cardiac and 1.32 to 2.65% in liver transplant hospitalizations; ptrend<0.01) increased from 2002-2013. This increase in AKI-D was explained by changes in race and increase in age and comorbidity burden of transplant hospitalizations. AKI-D was associated with increased odds of in hospital mortality (aOR 2.85; 95% CI 2.11-3.80 in cardiac and aOR 2.00; 95% CI 1.55-2.59 in liver transplant hospitalizations) and adverse discharge [discharge other than home] (aOR 1.97; 95% CI 1.53-2.55 in cardiac and 1.91; 95% CI 1.57-2.30 in liver transplant hospitalizations).ConclusionsThis study highlights the growing burden of AKI-D in non-renal solid organ transplant recipients and its devastating impact, and emphasizes the need to develop strategies to reduce the risk of AKI to improve health outcomes.
Highlights
The epidemiology and outcomes of acute kidney injury (AKI) in prevalent non-renal solid organ transplant recipients is unknown
Temporal trends of AKI in cardiac and liver transplant hospitalizations As shown in Fig. 1, the percentage of hospitalizations complicated by AKI in both cardiac and liver transplant hospitalizations tripled over the study period from 2002 to 2013 (9.7% to 32.7% in cardiac; ptrend
We demonstrate that the incidence of AKI requiring dialysis (AKI-D) in subsequent hospitalizations following cardiac and liver transplantations increased over time and is tenfold higher than in the general population without non-renal solid organ transplantation (NRSOT) [3]
Summary
The epidemiology and outcomes of acute kidney injury (AKI) in prevalent non-renal solid organ transplant recipients is unknown. Acute kidney injury (AKI) is an common condition in hospitalized patients [1], and is associated with high morbidity and mortality [2,3,4]. The incidence of non-renal solid organ transplantation (NRSOT) including cardiac and liver transplantation has been increasing in the United States [8]. NRSOT recipients are at risk of AKI in the short-term, and progressive loss of kidney function in the long-term, leading to endstage renal disease (ESRD) [9]. Risk of AKI in the short-term is primarily dependent on co-morbid conditions and post-operative complications (e.g. sepsis) associated with acute care hospitalizations. On the Nadkarni et al BMC Nephrology (2017) 18:244 other hand, long-term progressive loss of renal function is associated with multitude of factors, including exposure to calcineurin-inhibitor use and allograft dysfunction
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