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Kidney Week

Abstract: SA-PO1080

Association Between Early State of Volume Overload with Delayed Graft Function in Kidney Transplantation

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Reyna-Blanco, Juan, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
  • Merino, Maribel, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
  • Perez-Navarro, L. Monserrat, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
  • Valdez-Ortiz, Rafael, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
Background

Delayed graft function (DGF) following kidney transplantation (KT) is a common problem and has been associated with decreased graft survival and increased risk of acute rejection. One of the factors that has been poorly studied so far is the state of volume overload as a risk factor for DGF. The aim is to associate the state of volume overload estimated by the daily accumulated fluid balance and measured through bioimpedance vectors, ultrasonographic parameters, serum B-type natriuretic peptide (sBNP), and Ca-125 with the development of DGF.

Methods

All patients over 18 years undergoing KT were included. Fluid balance was recorded, sBNP and Ca-125 were measured. Electrical bioimpedance and ultrasound measurements were also performed such as diameter of the inferior vena cava (IVC) and the portal vein pulsatility fraction (PVPF). Measurements were taken before KT and then every 24 hours for 3 days after KT. The primary outcome was the development of DGF, defined as the need for renal replacement therapy within the first 7 days post-transplantation.

Results

A total of 34 patients with KT were included, with an average age of 31 (26-42) years, and the main type of renal transplant was deceased donor (68%). Eight patients (23.5%) developed DGF. Analysis of the volume status revealed that the accumulated balance at 72 h was -79.7 mL (-3648 to -1875 mL) in the non-DGF group and 5596 mL (5126 to 7232 mL) in those who developed DGF (p<0.001). Pretransplant sBNP levels were 100.1 pg/mL (38-248) without DGF vs 525 pg/mL (74-1815) with DGF; p=0.045. Pretransplant Ca-125 levels were 12.1 U/mL (7.9-19) without DGF vs 10.1 U/mL (9-13) with DGF; p=0.92. Pretransplant IVC diameter was 1.6 cm (1.4-1.7) without DGF vs 2.3 cm (range 1.7-2.4) with DGF; p=0.1. Pretransplant PVPF was 23% (17-31) without DGF vs 37% (25-71) with DGF; p=0.09. Pretransplant total body water was 35.8 L (32.1-38.6) without DGF vs 39.5 L (35.9-42.7) with DGF; p=0.31. Univariate analysis revealed that only pretransplant BNP levels were associated with the development of DGF (OR: 1.002, 95% CI:1.001-1.003; p=0.04).

Conclusion

Volume overload, estimated by accumulated fluid balance, was associated with the development of DGF. However, the use of different volume status biomarkers only revealed that sBNP at baseline were associated with the development of DGF.