Dr Masnun Kayes1,3,5, Mr Christopher Bragg2, Dr Renuka Shanmugalingam3,5,7, Professor Jacob Sevastos1,4,6
1Department of Renal Medicine, St Vincent’s Hospital, Sydney, 2Heart and Lung Transplant Unit, St Vincent’s Hospital, Sydney, 3Department of Renal Medicine, Liverpool Hospital, Sydney, 4School of Clinical Medicine, St Vincent’s Clinical School, University of New South Wales, 5School of Clinical Medicine, South West Sydney Clinical Campuses, University of New South Wales, 6School of Medicine, University of Notre Dame, Sydney, New South Wales, 7School of Medicine, Western Sydney University, New South Wales, ,
Aim: To evaluate factors associated with acute kidney injury (AKI), commencement of renal replacement therapy (RRT) and predictors of recovery post-cardiac transplantation.
Background: Cardiac transplantation is a definitive treatment for patients with end-stage heart failure on maximal medical therapy. A high incidence of post-operative AKI has been noted following cardiac transplantation. Little is known about incident RRT and recovery in this cohort.
Methods: Consecutive adult patients undergoing heart transplantation within our institution (Jan 2014–Dec 2018) were retrospectively evaluated. Appraisal of patient anthropometrics, clinical comorbidities, pharmacotherapeutics, and surgical/post-surgical course was undertaken. Patients were followed up for a minimum of 24 months for the outcomes of incident AKI (based on the Kidney Disease Improving Global Outcomes definition), RRT and recovery from AKI and RRT. Patients with chronic kidney disease stage 5, AKI by time of surgery or requiring RRT within the preceding 12 months of transplantation were excluded.
Results: Of 185 patients assessed (52.2±12.5years;62.2% men), 147(79.5%) developed an AKI and 55(29.7%) required RRT, of which 42 recovered function. Using a stepwise hierarchal backward logistic regression model, comorbid ischaemic heart disease (IHD) (adjOR 3.29;95%CI 1.23-8.82;P=0.02) increased the likelihood of developing an AKI post-operatively. Increasing surgical cardiopulmonary bypass time (adjOR 1.014;95%CI 1.01-1.02.5;P<0.001) and comorbid atrial fibrillation/flutter (adjOR 2.18;95%CI 1.01-4.71;P<0.05) increased the likelihood of requiring RRT. Angiotensin receptor blockade use (adjOR 0.31;95%CI 0.15-0.66;P=0.002) and loop diuretic use (adjOR 0.38;95%CI 0.15-0.99;P<0.05) reduced the likelihood of requiring RRT. Comorbid IHD(P=0.03), diabetes mellitus(P=0.02), cerebrovascular accident(P=0.03), ventricular assist device use(P=0.03) and increasing CPB time(P<0.001) were all associated with remaining on RRT long-term.
Conclusions: Our study identified key variables associated with incident AKI and RRT commencement post-cardiac transplantation.
Biography:
Dr Kayes is a final year renal advanced trainee in the Central and South West network in Sydney, NSW. He has worked extensively in busy metropolitan hospitals throughout the city. His research interests are in the epidemiology of chronic renal disease.