Outcomes of severe acute kidney injury requiring renal replacement therapy in renal transplant patients: A single center experience.

Objective: We aimed to assess the renal allograft and patient survival following acute kidney injury requiring dialysis therapy.

Methods: We analyzed the medical record of 3000 first living donor kidney transplant performed between 2008 to 2017 for AKI requiring dialysis at Sindh Institute of Urology and Transplantation, Karachi, Pakistan. Patients less than 15 years of age and those AKI events that happened less than three months post renal transplant were excluded. Renal allograft and patient survival were recorded at discharge and one-year post AKI. Recovery of renal functions was assessed at three-month.

Results: AKI requiring dialysis therapy was identified in 154 (5.1%) patients. At discharge, 115 (74.7%) were alive and 71 (61.7%) of them were dialysis free. At three-month, out of 71 dialysis free patients, 11 (15.5%) had complete recovery, 54 (76%) had partial recovery and six (8.5%) required dialysis again. At one-year, 98 (63.6%) patients were alive and 42 (42.9%) of them were dialysis free. Infectious etiology of AKI (P= 0.000; 0R 6.00; CI, 2.3-15.08) and more than two non-dialysis -requiring AKI in the past (P= 0.017; OR 3.04; CI, 1.2-7.5) were the risk factors of in-hospital mortality. Non-infectious cause of AKI (P=0.000; OR 45.5; CI, 9.9-206) and being off calcineurin inhibitors (P=0.014; OR 4.4; CI, 1.3-14.8) were the risk factors of dialysis dependency at hospital discharge.

Conclusions: Dialysis-requiring AKI secondary to infectious etiology has both high mortality and chances of recovery in survivors. They need prompt diagnosis and treatment. Non-infectious etiology and being off CNI are the risk factors of graft loss in dialysis-requiring AKI.