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Impact of acute kidney injury exposure period among liver transplantation patients

BACKGROUND: Acute kidney injury is a common complication of liver transplantation. In this single-centre retrospective observational study, we investigated the impact of acute kidney disease on liver recipient survival. METHODS: The study population consisted of patients who underwent a liver engraf...

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Autores principales: Narciso, Roberto Camargo, Ferraz, Leonardo Rolim, Mies, Sergio, Monte, Julio Cesar Martins, dos Santos, Oscar Fernando Pavão, Neto, Miguel Cendoroglo, Rodrigues, Cassio José de Oliveira, Batista, Marcelo Costa, Junior, Marcelino Souza Durão
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616838/
https://www.ncbi.nlm.nih.gov/pubmed/23425345
http://dx.doi.org/10.1186/1471-2369-14-43
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author Narciso, Roberto Camargo
Ferraz, Leonardo Rolim
Mies, Sergio
Monte, Julio Cesar Martins
dos Santos, Oscar Fernando Pavão
Neto, Miguel Cendoroglo
Rodrigues, Cassio José de Oliveira
Batista, Marcelo Costa
Junior, Marcelino Souza Durão
author_facet Narciso, Roberto Camargo
Ferraz, Leonardo Rolim
Mies, Sergio
Monte, Julio Cesar Martins
dos Santos, Oscar Fernando Pavão
Neto, Miguel Cendoroglo
Rodrigues, Cassio José de Oliveira
Batista, Marcelo Costa
Junior, Marcelino Souza Durão
author_sort Narciso, Roberto Camargo
collection PubMed
description BACKGROUND: Acute kidney injury is a common complication of liver transplantation. In this single-centre retrospective observational study, we investigated the impact of acute kidney disease on liver recipient survival. METHODS: The study population consisted of patients who underwent a liver engraftment between January 2002 and November 2006, at a single transplantation centre in São Paulo, Brazil. Acute kidney injury diagnosis and staging were according to the recommendations of the Acute Kidney Injury Network and consisted of scanning the daily serum creatinine levels throughout the hospital stay. Patients requiring renal replacement therapy prior to transplantation, those who developed acute kidney injury before the procedure or those receiving their second liver graft were excluded from the study. RESULTS: A total of 444 liver transplantations were performed during the study period, and 129 procedures (29%) were excluded. The remaining 315 patients constituted the study population. In 207 procedures, the recipient was male (65%). The mean age of the population was 51 years. Cumulative incidence of acute kidney injury within 48 h, during the first week after transplantation, and throughout the hospital stay was 32, 81 and 93%, respectively. Renal replacement therapy was required within a week after the transplantation in 31 procedures (10%), and another 17 (5%) required replacement therapy after that period. Mean follow-up period was 2.3 years. Time in days from acute kidney injury diagnosis to initiation of replacement therapy or reaching serum creatinine peak was associated with lower overall survival even when adjusted for significant potential confounders (HR 1.03; 95% CI 1.01, 1.05; p=0.002). Overall, patients experiencing acute kidney injury lasting for a week or more before initiation of replacement therapy experienced a threefold increase in risk of death (HR 3.02; 95% CI 2.04, 4.46; p<0.001). CONCLUSIONS: Acute kidney injury after liver transplantation is remarkably frequent and has a substantial impact on patient survival. Delaying the initiation of renal replacement therapy in such population may increase mortality by more than 20% per day.
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spelling pubmed-36168382013-04-05 Impact of acute kidney injury exposure period among liver transplantation patients Narciso, Roberto Camargo Ferraz, Leonardo Rolim Mies, Sergio Monte, Julio Cesar Martins dos Santos, Oscar Fernando Pavão Neto, Miguel Cendoroglo Rodrigues, Cassio José de Oliveira Batista, Marcelo Costa Junior, Marcelino Souza Durão BMC Nephrol Research Article BACKGROUND: Acute kidney injury is a common complication of liver transplantation. In this single-centre retrospective observational study, we investigated the impact of acute kidney disease on liver recipient survival. METHODS: The study population consisted of patients who underwent a liver engraftment between January 2002 and November 2006, at a single transplantation centre in São Paulo, Brazil. Acute kidney injury diagnosis and staging were according to the recommendations of the Acute Kidney Injury Network and consisted of scanning the daily serum creatinine levels throughout the hospital stay. Patients requiring renal replacement therapy prior to transplantation, those who developed acute kidney injury before the procedure or those receiving their second liver graft were excluded from the study. RESULTS: A total of 444 liver transplantations were performed during the study period, and 129 procedures (29%) were excluded. The remaining 315 patients constituted the study population. In 207 procedures, the recipient was male (65%). The mean age of the population was 51 years. Cumulative incidence of acute kidney injury within 48 h, during the first week after transplantation, and throughout the hospital stay was 32, 81 and 93%, respectively. Renal replacement therapy was required within a week after the transplantation in 31 procedures (10%), and another 17 (5%) required replacement therapy after that period. Mean follow-up period was 2.3 years. Time in days from acute kidney injury diagnosis to initiation of replacement therapy or reaching serum creatinine peak was associated with lower overall survival even when adjusted for significant potential confounders (HR 1.03; 95% CI 1.01, 1.05; p=0.002). Overall, patients experiencing acute kidney injury lasting for a week or more before initiation of replacement therapy experienced a threefold increase in risk of death (HR 3.02; 95% CI 2.04, 4.46; p<0.001). CONCLUSIONS: Acute kidney injury after liver transplantation is remarkably frequent and has a substantial impact on patient survival. Delaying the initiation of renal replacement therapy in such population may increase mortality by more than 20% per day. BioMed Central 2013-02-20 /pmc/articles/PMC3616838/ /pubmed/23425345 http://dx.doi.org/10.1186/1471-2369-14-43 Text en Copyright © 2013 Narciso et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Narciso, Roberto Camargo
Ferraz, Leonardo Rolim
Mies, Sergio
Monte, Julio Cesar Martins
dos Santos, Oscar Fernando Pavão
Neto, Miguel Cendoroglo
Rodrigues, Cassio José de Oliveira
Batista, Marcelo Costa
Junior, Marcelino Souza Durão
Impact of acute kidney injury exposure period among liver transplantation patients
title Impact of acute kidney injury exposure period among liver transplantation patients
title_full Impact of acute kidney injury exposure period among liver transplantation patients
title_fullStr Impact of acute kidney injury exposure period among liver transplantation patients
title_full_unstemmed Impact of acute kidney injury exposure period among liver transplantation patients
title_short Impact of acute kidney injury exposure period among liver transplantation patients
title_sort impact of acute kidney injury exposure period among liver transplantation patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616838/
https://www.ncbi.nlm.nih.gov/pubmed/23425345
http://dx.doi.org/10.1186/1471-2369-14-43
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