Abstract Details

Title The Relationship Between Diabetes Insipidus and Renal Function in Brain Dead Patients

Topic Neuro Trauma and Critical Care

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 2-003

Objective Examine if different degrees of renal dysfunction may impact the manifestation of Diabetes Insipidus (DI) in Brain Dead (BD) patients.

Background It has been reported that up to 50% of BD patients do not have signs of clinical DI, which suggests remaining hypothalamic/pituitary activity. However these studies have never accounted for presence or absence of renal dysfunction in those patients

Design/Methods

All adult patients declared BD over 12 years at a tertiary center were evaluated. DI was diagnosed by polyuria (>300 ml urine output for ≥2 consecutive hours), low urine specific gravity (< 1.005) and increasing serum sodium. Renal function was assessed by the estimated glomerular filtration rate (eGFR), calculated using the simplified Modification of Diet in Renal Disease (sMDRD) equation (validated for ages > 18)

Results 192/266 BD patients were included in the analysis after excluding those with missing data, < 18-years-old or on vasopressin infusions (for hypotension). 122 (63.5%) developed DI. The proportion with DI decreased significantly with decreasing eGFR: for eGFR > 60ml/min, DI was present in 77.2%; for eGFR 15-60ml/min in 54.5%, and for eGFR < 15ml/min in 32% (p < 0.001). There were 14 patients with eGFR < 9.7 ml/min (all with serum creatinine > 7.1 mg/dL); none experienced DI. Using logistic regression, for every 10 ml/min increase in eGFR the odds of DI increased by 1.2 times (95% CI: 1.10 to 1.32, p < 0.001)

Conclusions Presence of hypothalamic/pituitary activity (based on the absence of DI) may be less common than previously thought in BD patients, as kidney dysfunction significantly impacts DI manifestation. DI is observed less frequently in BD patients who have renal injury, and some patients with severe renal dysfunction never develop clinical DI. Renal dysfunction should be accounted for when considering the presence or absence of DI in brain death.

Authors/Disclosures
Panayiotis N. Varelas, MD, PhD, FAAN (Albany Med-Department of Neurology) PRESENTER	Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Astra Zeneca -Alexion - Portola. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Annexon. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca- Alexion-Portola. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Marinus. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Annexon. Dr. Varelas has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Giammarco, Mullins & Horton P.C. The institution of Dr. Varelas has received research support from Marinus. The institution of Dr. Varelas has received research support from Bayer. Dr. Varelas has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Rep to the RUC meeting with AAN. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving as a Speaker at the Annual Meeting with AAN. Dr. Varelas has a non-compensated relationship as a President - Past President with Neurocritical Care Society that is relevant to AAN interests or activities.
Mohammed Kananeh, MD (Hackensack University Medical Center)	Dr. Kananeh has nothing to disclose.
Paul D. Brady, MD (Henry Ford Hospital)	Dr. Brady has nothing to disclose.
Devin Holden (Albany Medical Center)	No disclosure on file
Ashar Ata (Albany Medical College)	No disclosure on file
Chandan B. Mehta, MD (Henry Ford Hospital)	Dr. Mehta has nothing to disclose.
David M. Greer, MD, FAAN (Boston University School of Medicine)	Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has a non-compensated relationship as a Treasurer-Elect with American Neurological Association that is relevant to AAN interests or activities. Dr. Greer has a non-compensated relationship as a President with Neurocritical Care Society that is relevant to AAN interests or activities.
Mohammed Rehman, DO (Henry Ford Hospital)	Dr. Rehman has nothing to disclose.

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