Analysis of risk factors for progression to chronic kidney disease following recovery from acute kidney injury after heart transplantation

CHEN Zhi-jin; ZHENG Cai-yan; HU Hao-fei; LI Ai-ting; QIN Le-le; ZENG Ting-ting; WANG Xin-ya; ZHANG Ze-han; YE Zhi-ming

doi:10.3969/j.issn.1009-8933.2025.2.lnxxgbzz-e202502004

Abstract：Background Acute kidney injury (AKI) is a frequent complication following heart transplantation. Some patients progress directly to chronic kidney disease (CKD), while a considerable proportion paradoxically exhibit rapid CKD progression despite a return of serum creatinine to normal levels following AKI resolution. This phenomenon adversely impacts long-term prognosis. This study aimed to inform early-risk stratification and preventive strategies for this vulnerable population. Methods This study enrolled 133 patients who underwent successful heart transplantation at Guangdong Provincial People's Hospital between January 1, 2017, and May 31, 2023, developed AKI within 7 days postoperatively, and achieved a return of serum creatinine to within the normal range within 3 months. At 18-month follow-up, we stratified patients into CKD and non-CKD groups using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Univariate and multivariable logistic regression were applied to identify predictors of CKD progression. Results During the 18-month follow-up period, 68 patients (51.1%) progressed to CKD following the return of serum creatinine to normal levels after AKI subsequent to heart transplantation. Subsequent multivariable analysis showed female sex [adjusted odds ratio (aOR): 11.128, 95%CI: 1.863-66.488, P=0.008], age (per year: aOR: 1.057, 95%CI: 1.008-1.109, P=0.023), preoperative valvular heart disease (aOR: 4.818, 95%CI: 1.588-14.618, P=0.005), baseline serum creatinine (per μmol/L: aOR: 1.093, 95%CI: 1.020-1.172, P=0.012), AKI Stage 2 (vs. Stage 1: aOR: 10.701, 95%CI: 2.177-52.596, P=0.004), Grade 4 hematuria (aOR: 8.915, 95%CI: 1.517-50.595, P=0.014) and AKI-phase random glucose (per mmol/L: aOR: 1.107, 95%CI: 1.009-1.214, P=0.032) were seven independent risk factors associated with CKD progression. The derived prediction model incorporating these seven independent risk factors demonstrated good discrimination [area under curve (AUC): 0.848, 95%CI: 0.784-0.911, P<0.001]. Conclusions Female sex, advanced age, preoperative valvular heart disease, elevated preoperative baseline serum creatinine, stage 2 AKI, gross hematuria (4+) during AKI, and elevated random blood glucose during AKI were independent risk factors for progression to CKD following the return of serum creatinine to normal levels after AKI in heart transplant recipients. Understanding these risk factors may help us identify high-risk patients and provide early intervention. [S Chin J Cardiol 2025;26(2):88-97]