Sepsis-Associated Acute Kidney Injury in Kidney Transplant Recipients in Intensive Care Unit

This study aimed to identify risk factors for sepsis-associated acute kidney injury (AKI) and estimate the impact of sepsis on graft function in kidney transplant recipients (KTRs).

This was a retrospective cohort study including 282 KTRs with sepsis admitted to the intensive care unit (ICU). Variables associated with AKI requiring renal replacement therapy (RRT) were analyzed using multivariable logistic regression, and the impact of sepsis on estimated glomerular filtration rate (eGFR, 2021-CKDEPI) was assessed using generalized estimating equations, adjusted by the Bonferroni test.

The eGFR 3 months before sepsis (baseline) was 41.0, declining to 26.8 at ICU admission (p < 0.001). Within 3 months after ICU admission, 39.7% of patients died, and 6.0% experienced graft loss. The AKI rate was 83.0%, with 35.5% (n = 100) requiring RRT. Of these, 38 survived, of whom 30 recovered graft function either to baseline levels or to a level that no longer required RRT, and 8 remained on RRT. Among survivors, the baseline eGFR was 39.4, decreasing to 26.0 at ICU admission (p < 0.001) and increasing to 34.8 three months later (p < 0.001). For survivors who required RRT (n = 38), the mean baseline eGFR was 34.1 mL/min/1.73 m², dropping to 15.3 mL/min/1.73 m² at ICU admission (p < 0.001) and increasing to 23.6 mL/min/1.73 m² at 3 months. Variables associated with AKI requiring RRT included diabetes (odds ratio [OR] yes vs. no = 2.17; p < 0.001), higher Sequential Organ Failure Assessment (SOFA) scores (OR for each point = 1.19; p = 0.004), and baseline eGFR (OR for each 1 mL/min = 0.98; p = 0.005).

Sepsis-associated AKI is a common complication in KTRs admitted to the ICU, with a high rate of RRT requirement influenced by baseline renal function. Despite the severity, graft function may recover in survivors, even among those with severe AKI.