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

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-09-16 DOI:10.1111/ctr.15457

Stefan Kuhnert, Janine Sommerlad, Henning Gall, Max M. Weder, Matthias Wolff, Sebastian Eberle, Michael Sander, Martin Reichert, Christian Koch, Ingolf Askevold, Andreas Hecker, Winfried Padberg, Marlies Ostermann, Ravindra Mehta, Claudio Ronco, Horst-Walter Birk, Werner Seeger, Konstantin Mayer, Matthias Hecker, Faeq Husain-Syed

{"title":"Postoperative Fluid Accumulation is Associated With Underestimation of AKI Severity in Lung Transplant Recipients","authors":"Stefan Kuhnert, Janine Sommerlad, Henning Gall, Max M. Weder, Matthias Wolff, Sebastian Eberle, Michael Sander, Martin Reichert, Christian Koch, Ingolf Askevold, Andreas Hecker, Winfried Padberg, Marlies Ostermann, Ravindra Mehta, Claudio Ronco, Horst-Walter Birk, Werner Seeger, Konstantin Mayer, Matthias Hecker, Faeq Husain-Syed","doi":"10.1111/ctr.15457","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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; <i>p</i> = 0.038). Persistent AKI was associated with higher mortality than transient AKI, regardless of using crude or adjusted SCr values (<i>p</i> < 0.05). Persistent AKI emerged as an independent risk factor for mortality (HR 2.35; 95% CI 1.29, 4.30; <i>p</i> = 0.005).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Trial Registration</h3>\n \n <p>ClinicalTrials.gov identifier: NCT03039959, NCT03046277.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.15457","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Transplantation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ctr.15457","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

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.

Abstract Image

查看原文本刊更多论文

肺移植受者术后积液与低估 AKI 严重程度有关

背景肺移植（LTx）后积液会导致血清肌酐（SCr）稀释。我们假设积液可能会影响移植后急性肾损伤（AKI）的诊断、分期和预后。方法在这项回顾性研究中，我们分析了 2005 年至 2018 年间德国一家肺科中心的 131 名成人 LTx 患者的数据。我们评估了移植术后 7 天内（根据体液平衡（FB）进行 SCr 调整之前和之后）发生的 AKI，并调查了其对全因死亡率的影响。短暂性和持续性 AKI 分别定义为肾功能恢复到基线水平或 AKI 持续超过 72 小时。结果根据粗 SCr 值，58.8% 的患者被诊断为 AKI。在考虑 FB 调整后的 SCr 值时，20.6% 的患者的 AKI 严重程度被低估，也就是说，另有 6.9% 的患者发现了 AKI，23.4% 的病例导致了 AKI 的升级。与未达到 AKI 标准的患者相比，最初被低估但经 FB 调整后才发现 AKI 的患者死亡率更高（危险比 [HR] 2.98；95% 置信区间 [CI] 1.06，8.36；P = 0.038）。与一过性 AKI 相比，无论使用粗略还是调整后的 SCr 值，持续性 AKI 都与更高的死亡率相关（p < 0.05）。持续性 AKI 成为死亡率的独立风险因素（HR 2.35；95% CI 1.29，4.30；P = 0.005）。结论对 FB 进行调整并评估 AKI 后的肾功能恢复模式可提高 AKI 检测的灵敏度。这种方法有助于识别预后不良的患者，并有可能改善肺移植受者的预后。试验注册 ClinicalTrials.gov identifier：NCT03039959、NCT03046277。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.