The incidence and consequences of acute kidney injury in kidney transplant recipients

In transplant recipients, little is known about the incidence and consequences of acute kidney injury (AKI) outside the peri-transplant period unrelated to acute rejection (AR). We identified AKI-related hospitalizations that occurred at least six months posttransplantation, excluding any AKI events in the same year as a recorded AR, in 28,485 adult Medicare-insured, first kidney-only transplant recipients with graft survival ≥6 months in the United States between 1995-2003. During the first three post-transplant years, 2720 (9.5%) patients had 3657 AKI-related hospitalizations. Death and allograft failure within 90 days of discharge occurred in 15.2% and 13.0% of AKI-related hospitalizations. AKI-related hospitalization was independently associated with an increased risk for graft loss from any cause (HR = 2.94, 95% CI: 2.53-3.41), death with a functioning graft (HR 2.58, 95% CI: 2.06-3.22), and death censored graft loss (HR 3.29, 95% CI: 2.70-4.02).