Abstract: TH-PO917

Comparison in Mortality in Dialysis Requiring AKI (AKI-D) in Native versus Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Singh, Tripti, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
  • Waheed, Sana, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
  • Djamali, Arjang, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
  • Garg, Neetika, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
  • Sipsma, Kristen, UW Health, Madison, Wisconsin, United States
Background

There is limited information on mortality rates in patients with native versus transplant kidneys requiring renal replacement therapy (RRT) for acute kidney injury (AKI).

Methods

We compared one-year patient outcomes in a retrospective single center analysis of all adult patients with acute kidney injury requiring dialysis (AKI-D) admitted between February 2012- June 2016.

Results

962 patients with native kidney (AKI-N) and 147 patients with kidney transplant (AKI-T) with AKI-D were admitted during the study period. Mean age was 57.6 years for AKI-N and 52.6 years for AKI-T patients (p=0.0001). 63% were males and 88% were Caucasians (p=ns). Serum creatinine at admission was significantly higher in AKI-T compared to AKI-N kidney patients (4.4 vs 3.2 mg/dL, p<0.0001). Length of stay was similar for both groups (21.6 vs 21.2 days). Continuous renal replacement therapy (CRRT) was utilized in 65% of AKI-N compared to 36.7% of AKI-T (p<0.0001). Mortality at discharge was significantly higher for AKI-N compared to AKI-T (35% vs 19.8%, p = 0.0002). However, 1 year mortality for AKI-D was not different between native and kidney transplant recipients (49% vs 41%, p=0.09) because of poor late outcomes in transplant recipients (Fig 1) . Logistic regression analyses determined CRRT (HR 3.6, 95% CI 2.8-4.7, p<0.0001), serum creatinine (HR 0.87 CI .82-.92, p<0.0001), LOS (HR 0.98 CI .98-.99, p<0.0001), and age (HR 1.01 CI 1.00-1.02, p<0.005), as significant predictors of one year mortality.

Conclusion

In patients with AKI requiring RRT early mortality is higher in native kidney disease while late mortality is greater in kidney transplant recipients. Overall, AKI requiring RRT is associated with nearly 40-50% mortality at one year, regardless of transplant status.