Postoperative Fluid Accumulation is Associated With Underestimation of AKI Severity in Lung Transplant Recipients.

Autor: Kuhnert S; Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany.; Department of Internal Medicine, Institute for Lung Health (ILH), Universities of Giessen and Marburg Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany., Sommerlad J; Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany., Gall H; Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany.; Department of Internal Medicine, Institute for Lung Health (ILH), Universities of Giessen and Marburg Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany., Weder MM; Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA., Wolff M; Department of Anesthesiology, Operative Intensive Care and Pain Therapy, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany., Eberle S; Department of Anesthesiology, Operative Intensive Care and Pain Therapy, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany., Sander M; Department of Anesthesiology, Operative Intensive Care and Pain Therapy, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany., Reichert M; Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany., Koch C; Department of Anesthesiology, Operative Intensive Care and Pain Therapy, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany., Askevold I; Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany., Hecker A; Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany., Padberg W; Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany., Ostermann M; Department of Intensive Care, King's College London, Guy's & St Thomas' Hospital, London, UK., Mehta R; Department of Medicine, University of California San Diego, La Jolla, California, USA., Ronco C; International Renal Research Institute of Vicenza, IRRIV Foundation, Vicenza, Italy.; Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy.; Department of Medicine (DIMED), Università di Padova, Padua, Italy., Birk HW; Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany., Seeger W; Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany.; Department of Internal Medicine, Institute for Lung Health (ILH), Universities of Giessen and Marburg Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany.; Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany., Mayer K; Department of Pulmonology and Sleep Medicine, ViDia Clinics, Karlsruhe, Germany., Hecker M; Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany.; Department of Internal Medicine, Institute for Lung Health (ILH), Universities of Giessen and Marburg Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany., Husain-Syed F; Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany.; International Renal Research Institute of Vicenza, IRRIV Foundation, Vicenza, Italy.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2024 Sep; Vol. 38 (9), pp. e15457.
DOI: 10.1111/ctr.15457
Abstrakt: Background: Post-lung transplantation (LTx) fluid accumulation can lead to dilution of serum creatinine (SCr). We hypothesized that fluid accumulation might impact the diagnosis, staging, and outcome of posttransplant acute kidney injury (AKI).
Methods: In this retrospective study, we analyzed data from 131 adult LTx patients at a single German lung center between 2005 and 2018. We assessed the occurrence of AKI within 7 days posttransplant, both before and after SCr-adjustment for fluid balance (FB), and investigated its impact on all-cause mortality. Transient and persistent AKIs were defined as return to baseline kidney function or continuation of AKI beyond 72 h of onset, respectively.
Results: AKI was diagnosed in 58.8% of patients according to crude SCr values. When considering FB-adjusted SCr values, AKI severity was underestimated in 20.6% of patients, that is, AKI was detected in an additional 6.9% of patients and led to AKI upstaging in 23.4% of cases. Patients initially underestimated but detected with AKI only after FB adjustment had higher mortality compared to those who did not meet AKI criteria (hazard ratio [HR] 2.98; 95% confidence interval [CI] 1.06, 8.36; p = 0.038). Persistent AKI was associated with higher mortality than transient AKI, regardless of using crude or adjusted SCr values (p < 0.05). Persistent AKI emerged as an independent risk factor for mortality (HR 2.35; 95% CI 1.29, 4.30; p = 0.005).
Conclusion: Adjusting for FB and evaluating renal recovery patterns post-AKI may enhance the sensitivity of AKI detection. This approach could help identify patients with poor prognosis and potentially improve outcomes in lung transplant recipients.
Trial Registration: ClinicalTrials.gov identifier: NCT03039959, NCT03046277.
(© 2024 The Author(s). Clinical Transplantation published by Wiley Periodicals LLC.)
Databáze: MEDLINE
Externí odkaz: