Acute kidney injury tied to worse outcomes in kidney transplant recipients with UTI

The development of acute kidney injury (AKI) seems to worsen the risk of graft loss in kidney transplant recipients (KTRs) with urinary tract infection (UTI), a recent study has found.

Researchers conducted a retrospective comparative analysis of 100 KRTs with urosepsis, 100 with UTI, and 100 without either complication. Outcomes assessed at 1 year included graft loss, acute rejection, and allograft function.

AKI developed more frequently in KRTs with urosepsis vs UTI (75.2 percent vs 41 percent). The occurrence of stage 2 (15.8 percent vs 4 percent; p=0.012) and stage 3 (20.8 percent vs 2 percent; p<0.0001) was also higher in those with urosepsis. In turn, 17 urosepsis KRTs needed renal replacement therapy, as opposed to only one patient in the UTI group.

Multivariate logistic regression showed that hospital admission for urinary sepsis is a significant correlate of the occurrence of UTI-AKI, increasing such likelihood by more than threefold (odds ratio [OR], 3.29, 95 percent confidence interval [CI], 1.54–7.04; p=0.002). Other notable risk factors include suboptimal allograft function, urinary obstruction, and low serum albumin.

In turn, 75.6 percent of patients ultimately recovered from stage 1 AKI, while 55 percent and 26.1 percent did so from stage 2 and stage 3 AKI, respectively. Steroid bolus in the acute phase of treatment was a strong indicator of recovery (OR, 4, 95 percent CI, 1.49–11.2; p=0.006), while worse AKI severity and the need for transfusion were negative predictors. Of note, the likelihood of recovery did not differ between urosepsis and UTI groups.

In terms of outcomes, the development of AKI led to a more than sixfold increase in the likelihood of 1-year death-censored graft loss (hazard ratio, 6.31, 95 percent CI, 1.45–27.5; p=0.014). Other significant risk factors included reduction of immunosuppression in the acute illness phase and the need for transfusion.