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Kidney Week

Abstract: PO0237

Risk of Renal Recovery Post Dialysis-Requiring AKI in Critically Ill Transplant Patients Receiving Calcineurin Inhibitors

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • McMahon, Blaithin A., Medical University of South Carolina, Charleston, South Carolina, United States
  • Browne, Maria Creciun, Medical University of South Carolina, Charleston, South Carolina, United States
  • Liske-Doorandish, Dariush, Medical University of South Carolina, Charleston, South Carolina, United States
  • Okamoto, Keisuke, Nara Daigaku, Nara, Nara, Japan
Background

The use of the calcineurin inhibitors has led to major advances in the field of transplantation, with excellent short-term graft outcomes. However, these agents are associated with chronic nephrotoxicity and long-term may lead to ESRD. The purpose of this study was to assess the risk of renal recovery at 3 months in critically ill transplant and non-transplant patients who required continuous renal replacement therapy (CRRT) (AKI-D).

Methods

This is a single center retrospective study aimed to assess differences in renal recovery from AKI-requiring dialysis (AKI-D) in both non-transplant patients (CNI - patients ) and transplant patients taking calcineurin inhibitors (CNI + patients). Our study was undertaken from 02/2017 to 07/2019 at the Medical University of South Carolina, and our analysis included 153 critically ill patients who received CRRT for AKI-D. Non-renal recovery from AKI-D was defined as ESRD as per KDIGO guidelines. We performed a Cox Hazard Risk Model to asess risk of CNI use on renal recovery at 3 months adjusted for transplant status, mortality at 28 or 90 days, age, sex, hypertension, DM, APACHE score and initial number of vasoactive medication used at that time of CRRT initiation.

Results

CNI users had 61% lower risk of developing end stage kidney disease compared to non-CNI users at 90 days (HR 0.49, p = 0.49, CI 0.07 -3.69) although this risk was not statistically significantly. Interestingly, there was a statistically significant lower rate of 28-day and 90-day mortality in the critically ill transplant AKI-D cohort (21% and 37%, p< 0.05) when compared to the critically ill non-transplant AKI-D cohort (57% and 61%, p<0.05), respectively (see figure)

Conclusion

Even in this small retrospective cohort analysis, critically ill AKI-D patients requiring CNI agents did not have a statistically significant higher rate of ESRD despite CNI use and was associated with a lower 28- and 90-day mortality. More research is required to study the relationship between CNI use on renal recovery.