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Kidney Week

Abstract: TH-PO030

Kinetic Estimated Glomerular Filtration Rate (KeGFR) in Liver Transplantation: An Early Predictor of Significant AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Olivas-Martínez, Antonio, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
  • Martinez-Rueda, Armando Jezael, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
  • Zavala-Garcia, Gerardo, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
  • Bazua-Valenti, Silvana, Instituto de Investigaciones Biomedicas, UNAM, Mexico City, Mexico
  • García juárez, Ignacio, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
  • Correa-Rotter, Ricardo, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
Background

Acute kidney injury (AKI) is a common clinical problem in patients undergoing liver transplantation (LT) and up to 20% of these patients progress to CKD. Kinetic estimated glomerular filtration rate (KeGFR) is a recommended formula in non-steady states. Aim: to evaluate the diagnostic yield of KeGFR for early prediction of AKI in patients following LT.

Methods

We retrospectively studied all patients who underwent LT from 06/ 2017 to 04/2018. Clinical data and all SCr measurements during the first 5 days after transplantation were recorded. SCr before surgery was considered as baseline. Significant AKI was defined as an increase of at least 2 times in SCr baseline or requirement of renal replacement therapy (RRT). Early decline of eGFR was defined as a decreased of more than 50% from baseline eGFR in the first postoperative 24 hours. Early decline of eGFR was evaluated by the KeGFR, Cockfort-Gault, CKD-EPI, and MDRD-4 formulas and compared with the development of significant AKI in the first 5 postoperative days.

Results

Forty nine patients were included, mean age of 47.3 ± 11.68 y, 55.1% were female. Median baseline SCr was 0.7 mg/dL (range 0.43 - 3.03). Three patients had significant AKI prior transplantation. Twenty-four (49.0%) patients developed significant AKI in the first 5 days postoperative, of which 33.3% required RRT and 12.5% died. Diagnostic performance of studied formulas is shown in Table 1.

Conclusion

KeGFR was the only formula that predicted significant AKI within the first 24 hours, with a high sensitivity (87%) and a strong negative likelihood ratio (0.17) and improved area under the curve (0.846). The KeGFR formula is an affordable diagnostic tool, which improves our capability of significantly detecting AKI in patients following liver transplantation.

Table 1. Diagnostic performance (early decline in eGFR) at 24 hours following liver transplantation
FormulaSe (%)Sp (%)PPV (%)NPV (%)+LR-LRDiagnostic yield (%)AUC†
Kinetic eGFR87.572.075.085.73.130.1779.60.846
Cockroft-Gault25.0100.0100.058.10.7563.30.774
CKD-EPI25.0100.0100.058.10.7563.30.787
MDRD-429.296.087.558.57.290.7463.30.776
Se: sensitivity. Sp: specificity. PPV: positive predictive value. NPV: negative predictive value. +LR: positive likelihood ratio. –LR: negative likelihood ratio. AUC: area under the curve. †AUC obtained from ROC analysis using the maximum proportional decline in eGFR from baseline in the first 24 hours for each patient.