Incidence of AKI and Electrolyte Abnormalities in Brain-Dead Potential Organ Donor Patients: A Single-Center Experience

Background: Acute kidney injury is one of the most common complications in brain-dead potential organ donors, with an incidence ranging from 10.8% to 30.9%. Electrolyte abnormalities such as hypokalemia and hypernatremia are also frequent and are associated with delayed graft function in the recipient after transplant. Jacobi Medical Center is a level 1 trauma center, and a well-functioning donor hospital recognized by Centers for Medicare and Medicaid Services. We aimed to analyze the incidence of acute kidney injury and electrolyte abnormalities in the brain-dead potential organ donors. Methods: We conducted a retrospective study of adult patients declared as brain dead at Jacobi Medical Center from 2022 to 2024. Results: There were 131 brain-dead adult patients, of whom 63.4% were males. The mean age was 48 years (range: 18 to 94 years). The majority of patients were African Americans (40.5%), followed by Hispanics (38.9%) and Whites (15.3%). The mean body mass index was 26.4 kg/m2 (range: 15 to 47.9 kg/m2). Regarding comorbidities, 35.1% of patients had hypertension, 22.9% had diabetes mellitus, 6.1% had chronic kidney disease, and 6.9% had heart failure. Eighty-four patients (64.1%) had acute kidney injury: stage 1 (24.4%), stage 2 (16%) and stage 3 (24.4%). Among risk factors for acute kidney injury, 58% patients had cardiac arrest history, 90.8% of patients required vasopressors, 60.8% received intravenous contrast, and 27.5% had sepsis. The most common electrolyte abnormalities were hypernatremia (78.6%), hypokalemia (53.4%), hypophosphatemia (56.5%), and hyperglycemia (74.8%). Ten patients (7.6%) required renal replacement therapy. Conclusion: Acute kidney injury and electrolyte abnormalities are very commonly seen in patients after brain death. Early involvement of nephrologists in the clinical course might be beneficial to manage the complications after brain death to optimize patients for potential organ donation, and also to improve graft function.