Acute kidney injury in renal transplant recipients undergoing cardiac surgery

Gregory L. Hundemer; Anand Srivastava; Kirolos A. Jacob; Neeraja Krishnasamudram; Salman Ahmed; Emily Boerger; Shreyak Sharma; Kapil K. Pokharel; Sameer A. Hirji; Marc Pelletier; Kassem Safa; Win Kulvichit; John A. Kellum; Leonardo V. Riella; David E. Leaf

doi:10.1093/NDT/GFAA063

Acute kidney injury in renal transplant recipients undergoing cardiac surgery

Gregory L. Hundemer^*, Anand Srivastava, Kirolos A. Jacob, Neeraja Krishnasamudram, Salman Ahmed, Emily Boerger, Shreyak Sharma, Kapil K. Pokharel, Sameer A. Hirji, Marc Pelletier, Kassem Safa, Win Kulvichit, John A. Kellum, Leonardo V. Riella, David E. Leaf

^*Corresponding author for this work

Medicine, Nephrology Division

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

6 Scopus citations

Abstract

Background. Acute kidney injury (AKI) is a key risk factor for chronic kidney disease in the general population, but has not been investigated in detail among renal transplant recipients (RTRs). We investigated the incidence, severity and risk factors for AKI following cardiac surgery among RTRs compared with non-RTRs with otherwise similar clinical characteristics. Methods. We conducted a retrospective cohort study of RTRs (n=83) and non-RTRs (n=83) who underwent cardiac surgery at two major academic medical centers. Non-RTRs were matched 1:1 to RTRs by age, preoperative (preop) estimated glomerular filtration rate and type of cardiac surgery. We defined AKI according to Kidney Disease: Improving Global Outcomes criteria. Results. RTRs had a higher rate of AKI following cardiac surgery compared with non-RTRs [46% versus 28%; adjusted odds ratio 2.77 (95% confidence interval 1.36-5.64)]. Among RTRs, deceased donor (DD) versus living donor (LD) status, as well as higher versus lower preop calcineurin inhibitor (CNI) trough levels, were associated with higher rates of AKI (57% versus 33% among DDRTRs versus LD-RTRs; P=0.047; 73% versus 36% among RTRs with higher versus lower CNI trough levels, P=0.02). The combination of both risk factors (DD status and higher CNI trough level) had an additive effect (88% AKI incidence among patients with both risk factors versus 25% incidence among RTRs with neither risk factor, P=0.004). Conclusions. RTRs have a higher risk of AKI following cardiac surgery compared with non-RTRs with otherwise similar characteristics. Among RTRs, DD-RTRs and those with higher preop CNI trough levels are at the highest risk.

Original language	English (US)
Pages (from-to)	185-196
Number of pages	12
Journal	Nephrology Dialysis Transplantation
Volume	36
Issue number	1
DOIs	https://doi.org/10.1093/NDT/GFAA063
State	Published - 2021

Funding

G.L.H. is supported by a Kidney Research Scientist Core Education and National Training Program New Investigator Award from the Kidney Foundation of Canada. D.E.L. is supported by K23DK106448 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases and by an American Society of Nephrology Foundation for Kidney Research Carl W. Gottschalk Research Scholar Grant.

Keywords

Acute kidney injury
Calcineurin inhibitor
Cardiac surgery
Kidney transplant
Renal transplant

ASJC Scopus subject areas

Nephrology
Transplantation

UN SDGs

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

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10.1093/NDT/GFAA063

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Hundemer, G. L., Srivastava, A., Jacob, K. A., Krishnasamudram, N., Ahmed, S., Boerger, E., Sharma, S., Pokharel, K. K., Hirji, S. A., Pelletier, M., Safa, K., Kulvichit, W., Kellum, J. A., Riella, L. V., & Leaf, D. E. (2021). Acute kidney injury in renal transplant recipients undergoing cardiac surgery. Nephrology Dialysis Transplantation, 36(1), 185-196. https://doi.org/10.1093/NDT/GFAA063

@article{6e9d7fbab97c4a77b3d0f5098b0e7b56,

title = "Acute kidney injury in renal transplant recipients undergoing cardiac surgery",

abstract = "Background. Acute kidney injury (AKI) is a key risk factor for chronic kidney disease in the general population, but has not been investigated in detail among renal transplant recipients (RTRs). We investigated the incidence, severity and risk factors for AKI following cardiac surgery among RTRs compared with non-RTRs with otherwise similar clinical characteristics. Methods. We conducted a retrospective cohort study of RTRs (n=83) and non-RTRs (n=83) who underwent cardiac surgery at two major academic medical centers. Non-RTRs were matched 1:1 to RTRs by age, preoperative (preop) estimated glomerular filtration rate and type of cardiac surgery. We defined AKI according to Kidney Disease: Improving Global Outcomes criteria. Results. RTRs had a higher rate of AKI following cardiac surgery compared with non-RTRs [46% versus 28%; adjusted odds ratio 2.77 (95% confidence interval 1.36-5.64)]. Among RTRs, deceased donor (DD) versus living donor (LD) status, as well as higher versus lower preop calcineurin inhibitor (CNI) trough levels, were associated with higher rates of AKI (57% versus 33% among DDRTRs versus LD-RTRs; P=0.047; 73% versus 36% among RTRs with higher versus lower CNI trough levels, P=0.02). The combination of both risk factors (DD status and higher CNI trough level) had an additive effect (88% AKI incidence among patients with both risk factors versus 25% incidence among RTRs with neither risk factor, P=0.004). Conclusions. RTRs have a higher risk of AKI following cardiac surgery compared with non-RTRs with otherwise similar characteristics. Among RTRs, DD-RTRs and those with higher preop CNI trough levels are at the highest risk.",

keywords = "Acute kidney injury, Calcineurin inhibitor, Cardiac surgery, Kidney transplant, Renal transplant",

author = "Hundemer, {Gregory L.} and Anand Srivastava and Jacob, {Kirolos A.} and Neeraja Krishnasamudram and Salman Ahmed and Emily Boerger and Shreyak Sharma and Pokharel, {Kapil K.} and Hirji, {Sameer A.} and Marc Pelletier and Kassem Safa and Win Kulvichit and Kellum, {John A.} and Riella, {Leonardo V.} and Leaf, {David E.}",

note = "Funding Information: G.L.H. is supported by a Kidney Research Scientist Core Education and National Training Program New Investigator Award from the Kidney Foundation of Canada. D.E.L. is supported by K23DK106448 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases and by an American Society of Nephrology Foundation for Kidney Research Carl W. Gottschalk Research Scholar Grant. Publisher Copyright: {\textcopyright} 2021 Oxford University Press. All rights reserved.",

year = "2021",

doi = "10.1093/NDT/GFAA063",

language = "English (US)",

volume = "36",

pages = "185--196",

journal = "Nephrology Dialysis Transplantation",

issn = "0931-0509",

publisher = "Oxford University Press",

number = "1",

}

Hundemer, GL, Srivastava, A, Jacob, KA, Krishnasamudram, N, Ahmed, S, Boerger, E, Sharma, S, Pokharel, KK, Hirji, SA, Pelletier, M, Safa, K, Kulvichit, W, Kellum, JA, Riella, LV & Leaf, DE 2021, 'Acute kidney injury in renal transplant recipients undergoing cardiac surgery', Nephrology Dialysis Transplantation, vol. 36, no. 1, pp. 185-196. https://doi.org/10.1093/NDT/GFAA063

TY - JOUR

T1 - Acute kidney injury in renal transplant recipients undergoing cardiac surgery

AU - Hundemer, Gregory L.

AU - Srivastava, Anand

AU - Jacob, Kirolos A.

AU - Krishnasamudram, Neeraja

AU - Ahmed, Salman

AU - Boerger, Emily

AU - Sharma, Shreyak

AU - Pokharel, Kapil K.

AU - Hirji, Sameer A.

AU - Pelletier, Marc

AU - Safa, Kassem

AU - Kulvichit, Win

AU - Kellum, John A.

AU - Riella, Leonardo V.

AU - Leaf, David E.

N1 - Funding Information: G.L.H. is supported by a Kidney Research Scientist Core Education and National Training Program New Investigator Award from the Kidney Foundation of Canada. D.E.L. is supported by K23DK106448 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases and by an American Society of Nephrology Foundation for Kidney Research Carl W. Gottschalk Research Scholar Grant. Publisher Copyright: © 2021 Oxford University Press. All rights reserved.

PY - 2021

Y1 - 2021

N2 - Background. Acute kidney injury (AKI) is a key risk factor for chronic kidney disease in the general population, but has not been investigated in detail among renal transplant recipients (RTRs). We investigated the incidence, severity and risk factors for AKI following cardiac surgery among RTRs compared with non-RTRs with otherwise similar clinical characteristics. Methods. We conducted a retrospective cohort study of RTRs (n=83) and non-RTRs (n=83) who underwent cardiac surgery at two major academic medical centers. Non-RTRs were matched 1:1 to RTRs by age, preoperative (preop) estimated glomerular filtration rate and type of cardiac surgery. We defined AKI according to Kidney Disease: Improving Global Outcomes criteria. Results. RTRs had a higher rate of AKI following cardiac surgery compared with non-RTRs [46% versus 28%; adjusted odds ratio 2.77 (95% confidence interval 1.36-5.64)]. Among RTRs, deceased donor (DD) versus living donor (LD) status, as well as higher versus lower preop calcineurin inhibitor (CNI) trough levels, were associated with higher rates of AKI (57% versus 33% among DDRTRs versus LD-RTRs; P=0.047; 73% versus 36% among RTRs with higher versus lower CNI trough levels, P=0.02). The combination of both risk factors (DD status and higher CNI trough level) had an additive effect (88% AKI incidence among patients with both risk factors versus 25% incidence among RTRs with neither risk factor, P=0.004). Conclusions. RTRs have a higher risk of AKI following cardiac surgery compared with non-RTRs with otherwise similar characteristics. Among RTRs, DD-RTRs and those with higher preop CNI trough levels are at the highest risk.

AB - Background. Acute kidney injury (AKI) is a key risk factor for chronic kidney disease in the general population, but has not been investigated in detail among renal transplant recipients (RTRs). We investigated the incidence, severity and risk factors for AKI following cardiac surgery among RTRs compared with non-RTRs with otherwise similar clinical characteristics. Methods. We conducted a retrospective cohort study of RTRs (n=83) and non-RTRs (n=83) who underwent cardiac surgery at two major academic medical centers. Non-RTRs were matched 1:1 to RTRs by age, preoperative (preop) estimated glomerular filtration rate and type of cardiac surgery. We defined AKI according to Kidney Disease: Improving Global Outcomes criteria. Results. RTRs had a higher rate of AKI following cardiac surgery compared with non-RTRs [46% versus 28%; adjusted odds ratio 2.77 (95% confidence interval 1.36-5.64)]. Among RTRs, deceased donor (DD) versus living donor (LD) status, as well as higher versus lower preop calcineurin inhibitor (CNI) trough levels, were associated with higher rates of AKI (57% versus 33% among DDRTRs versus LD-RTRs; P=0.047; 73% versus 36% among RTRs with higher versus lower CNI trough levels, P=0.02). The combination of both risk factors (DD status and higher CNI trough level) had an additive effect (88% AKI incidence among patients with both risk factors versus 25% incidence among RTRs with neither risk factor, P=0.004). Conclusions. RTRs have a higher risk of AKI following cardiac surgery compared with non-RTRs with otherwise similar characteristics. Among RTRs, DD-RTRs and those with higher preop CNI trough levels are at the highest risk.

KW - Acute kidney injury

KW - Calcineurin inhibitor

KW - Cardiac surgery

KW - Kidney transplant

KW - Renal transplant

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U2 - 10.1093/NDT/GFAA063

DO - 10.1093/NDT/GFAA063

M3 - Article

C2 - 32892219

AN - SCOPUS:85099172041

SN - 0931-0509

VL - 36

SP - 185

EP - 196

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

IS - 1

ER -

Acute kidney injury in renal transplant recipients undergoing cardiac surgery

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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