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. 2020 Sep;115(9):1505-1512.
doi: 10.14309/ajg.0000000000000670.

Hospital-Acquired Versus Community-Acquired Acute Kidney Injury in Patients With Cirrhosis: A Prospective Study

Kavish R Patidar  1 , Hani Shamseddeen  1 , Chenjia Xu  2 , Marwan S Ghabril  1 , Lauren D Nephew  1 , Archita P Desai  1 , Melissa Anderson  3 , Tarek M El-Achkar  3 , Pere Ginès  4 , Naga P Chalasani  1 , Eric S Orman  1
Affiliations

Hospital-Acquired Versus Community-Acquired Acute Kidney Injury in Patients With Cirrhosis: A Prospective Study

Kavish R Patidar et al. Am J Gastroenterol. 2020 Sep.

Abstract

Introduction: In patients with cirrhosis, differences between acute kidney injury (AKI) at the time of hospital admission (community-acquired) and AKI occurring during hospitalization (hospital-acquired) have not been explored. We aimed to compare patients with hospital-acquired AKI (H-AKI) and community-acquired AKI (C-AKI) in a large, prospective study.

Methods: Hospitalized patients with cirrhosis were enrolled (N = 519) and were followed for 90 days after discharge for mortality. The primary outcome was mortality within 90 days; secondary outcomes were the development of de novo chronic kidney disease (CKD)/progression of CKD after 90 days. Cox proportional hazards and logistic regressions were used to determine the independent association of either AKI for primary and secondary outcomes, respectively.

Results: H-AKI occurred in 10%, and C-AKI occurred in 25%. In multivariable Cox models adjusting for significant confounders, only patients with C-AKI had a higher risk for mortality adjusting for model for end-stage liver disease-Na: (hazard ratio 1.64, 95% confidence interval [CI] 1.04-2.57, P = 0.033) and adjusting for acute on chronic liver failure: (hazard ratio 2.44, 95% CI 1.63-3.65, P < 0.001). In univariable analysis, community-acquired-AKI, but not hospital-acquired-AKI, was associated with de novo CKD/progression of CKD (odds ratio 2.13, 95% CI 1.09-4.14, P = 0.027), but in multivariable analysis, C-AKI was not independently associated with de novo CKD/progression of CKD. However, when AKI was dichotomized by stage, C-AKI stage 3 was independently associated with de novo CKD/progression of CKD (odds ratio 4.79, 95% CI 1.11-20.57, P = 0.035).

Discussion: Compared with H-AKI, C-AKI is associated with increased mortality and de novo CKD/progression of CKD in patients with cirrhosis. Patients with C-AKI may benefit from frequent monitoring after discharge to improve outcomes.

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Conflict of interest statement

Conflicts of Interest: Dr. Naga Chalasani has ongoing consulting activities (or had in the preceding 12 months) with NuSirt, AbbVie, Eli Lilly, Afimmune (DS Biopharma), Allergan (Tobira), Madrigal, Shire, Axovant, Coherus, Siemens, Centurion, and Genentech. He has received research support from Lilly, Galectin, Gilead, Exact Sciences, and Cumberland. Dr. Pere Ginès has received research funding from Mallinckrodt, Grifols and Gilead S.A. He has participated on Advisory Boards for Novartis, Promethera, Sequana, Gilead, Martin Pharmaceuticals, Ferring Pharmaceuticals and Grifols. The remaining authors disclose no conflicts.

Figures

Figure 1:
Figure 1:. Comparisons Between Community-Acquired AKI and Hospital-acquired AKI for AKI stage at Diagnosis and Peak.
AKI: acute kidney injury
Figure 2:
Figure 2:. Kaplan Meier Curve for Time to Death Stratified by AKI status.
AKI: acute kidney injury; C-AKI: community-acquired AKI; H-AKI: hospital-acquired AKI.
See this image and copyright information in PMC

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