TY - JOUR
T1 - Risk factors for acute kidney injury requiring renal replacement therapy after orthotopic heart transplantation in patients with preserved renal function
AU - M‘pembele, René
AU - Roth, Sebastian
AU - Stroda, Alexandra
AU - Buse, Giovanna Lurati
AU - Sixt, Stephan U.
AU - Westenfeld, Ralf
AU - Polzin, Amin
AU - Rellecke, Philipp
AU - Tudorache, Igor
AU - Hollmann, Markus W.
AU - Aubin, Hug
AU - Akhyari, Payam
AU - Lichtenberg, Artur
AU - Huhn, Ragnar
AU - Boeken, Udo
N1 - Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Acute kidney injury (AKI), requiring renal replacement therapy (RRT). is a serious complication after orthotopic heart transplantation (HTX). In patients with preexisting impaired renal function, postoperative AKI is unsurprising. However, even in patients with preserved renal func-tion, AKI requiring RRT is frequent. Therefore, this study aimed to identify risk factors associated with postoperative AKI requiring RRT after HTX in this sub-cohort. This retrospective cohort study included patients ≥18 years of age with preserved renal function (defined as preoperative glomerular filtration rate ≥60 mL/min) who underwent HTX between 2010 and 2021. In total, 107 patients were included in the analysis (mean age 52 ± 12 years, 78.5% male, 45.8% AKI requiring RRT). Based on univariate logistic regression, use of extracorporeal membrane oxygenation, postoperative infec-tion, levosimendan therapy, duration of norepinephrine (NE) therapy and maximum daily increase in tacrolimus plasma levels were chosen to be included into multivariate analysis. Duration of NE therapy and maximum daily increase in tacrolimus plasma levels remained as independent signif-icant risk factors (NE: OR 1.01, 95%CI: 1.00–1.02, p = 0.005; increase in tacrolimus plasma level: OR 1.18, 95%CI: 1.01–1.37, p = 0.036). In conclusion, this study identified long NE therapy and maximum daily increase in tacrolimus plasma levels as risk factors for AKI requiring RRT in HTX patients with preserved renal function.
AB - Acute kidney injury (AKI), requiring renal replacement therapy (RRT). is a serious complication after orthotopic heart transplantation (HTX). In patients with preexisting impaired renal function, postoperative AKI is unsurprising. However, even in patients with preserved renal func-tion, AKI requiring RRT is frequent. Therefore, this study aimed to identify risk factors associated with postoperative AKI requiring RRT after HTX in this sub-cohort. This retrospective cohort study included patients ≥18 years of age with preserved renal function (defined as preoperative glomerular filtration rate ≥60 mL/min) who underwent HTX between 2010 and 2021. In total, 107 patients were included in the analysis (mean age 52 ± 12 years, 78.5% male, 45.8% AKI requiring RRT). Based on univariate logistic regression, use of extracorporeal membrane oxygenation, postoperative infec-tion, levosimendan therapy, duration of norepinephrine (NE) therapy and maximum daily increase in tacrolimus plasma levels were chosen to be included into multivariate analysis. Duration of NE therapy and maximum daily increase in tacrolimus plasma levels remained as independent signif-icant risk factors (NE: OR 1.01, 95%CI: 1.00–1.02, p = 0.005; increase in tacrolimus plasma level: OR 1.18, 95%CI: 1.01–1.37, p = 0.036). In conclusion, this study identified long NE therapy and maximum daily increase in tacrolimus plasma levels as risk factors for AKI requiring RRT in HTX patients with preserved renal function.
KW - Calcineurin inhibitors
KW - Cardiac surgery
KW - Heart failure
KW - Prognosis
KW - Tacrolimus
KW - Vasopressors
UR - http://www.scopus.com/inward/record.url?scp=85114705077&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/jcm10184117
DO - https://doi.org/10.3390/jcm10184117
M3 - Article
C2 - 34575227
SN - 2077-0383
VL - 10
JO - Journal of clinical medicine
JF - Journal of clinical medicine
IS - 18
M1 - 4117
ER -