Incidence and outcomes of acute kidney injury including hepatorenal syndrome in hospitalized patients with cirrhosis in the US Article

Full Text via DOI: 10.1016/j.jhep.2023.07.010 Web of Science: 001130421900001

Cited authors

  • Patidar KR, Belcher JM, Regner KR, Hillien SAS, Simonetto DA, Asrani SK, Neyra JA, Sharma P, Velez JCQ, Wadei H, Nadim MK, Chung RT, Seethapathy R, Parada XV, Ouyang TQ, Ufere NN, Robinson JE, Diaz PM, Wilechansky RM, Przybyszewski EM, Smith TN, Ali AA, Orman ES, Schulz P, Siddiqui SM, Shabbir R, Liu LJ, Cama-Olivares A, Flannery AH, Baker ML, Gunasekaran D, Aswine A, Issa R, Li JY, Verma S, Chalmers D, Varghese V, Lam W, Mohamed M, Kovacic R, Gaddy A, Attieh RM, Cortes P, Semnani S, Wang L, Khemichian S, Allegretti AS

Abstract

  • Background & Aims: Acute kidney injury (AKI) in cirrhosis is common and associated with high morbidity, but the incidence rates of different etiologies of AKI are not well described in the US. We compared incidence rates, practice patterns, and outcomes across etiologies of AKI in cirrhosis.Methods: We performed a retrospective cohort study of 11 hospital networks, including consecutive adult patients admitted with AKI and cirrhosis in 2019. The etiology of AKI was adjudicated based on pre-specified clinical definitions (prerenal/hypovolemic AKI, hepatorenal syndrome [HRS-AKI], acute tubular necrosis [ATN], other).Results: A total of 2,063 patients were included (median age 62 [IQR 54-69] years, 38.3% female, median MELD-Na score 26 [19-31]). The most common etiology was prerenal AKI (44.3%), followed by ATN (30.4%) and HRS-AKI (12.1%); 6.0% had other AKI, and 7.2% could not be classified. In our cohort, 8.1% of patients received a liver transplant and 36.5% died by 90 days. The lowest rate of death was observed in patients with prerenal AKI (22.2%; p <0.001), while death rates were higher but not significantly different from each other in those with HRS-AKI and ATN (49.0% vs. 52.7%; p = 0.42). Using prerenal AKI as a reference, the adjusted subdistribution hazard ratio (sHR) for 90-day mortality was higher for HRS-AKI (sHR 2.78; 95% CI 2.18-3.54; p <0.001) and ATN (sHR 2.83; 95% CI 2.36-3.41; p <0.001). In adjusted analysis, higher AKI stage and lack of complete response to treatment were associated with an increased risk of 90-day mortality (p <0.001 for all).Conclusion: AKI is a severe complication of cirrhosis. HRS-AKI is uncommon and is associated with similar outcomes to ATN. The etiology of AKI, AKI stage/severity, and non-response to treatment were associated with mortality. Further optimization of vasoconstrictors for HRS-AKI and supportive therapies for ATN are needed.

Authors

Publication date

  • 2023

Published in

International Standard Serial Number (ISSN)

  • 0168-8278

Number of pages

  • 11

Start page

  • 1408

End page

  • 1417

Volume

  • 79

Issue

  • 6