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. 2022 Jul;77(1):108-115.
doi: 10.1016/j.jhep.2022.02.009. Epub 2022 Feb 23.

Acute kidney disease is common and associated with poor outcomes in patients with cirrhosis and acute kidney injury

Kavish R Patidar  1 , Mobasshir A Naved  2 , Ananth Grama  2 , Mohammad Adibuzzaman  3 , Arzina Aziz Ali  4 , James E Slaven  5 , Archita P Desai  6 , Marwan S Ghabril  6 , Lauren Nephew  6 , Naga Chalasani  6 , Eric S Orman  6
Affiliations

Acute kidney disease is common and associated with poor outcomes in patients with cirrhosis and acute kidney injury

Kavish R Patidar et al. J Hepatol. 2022 Jul.

Abstract

Background & aims: Acute kidney disease (AKD) is the persistence of acute kidney injury (AKI) for up to 3 months, which is proposed to be the time-window where critical interventions can be initiated to alter downstream outcomes of AKI. In cirrhosis, AKD and its impact on outcomes have been scantly investigated. We aimed to define the incidence and outcomes associated with AKD in a nationwide US cohort of hospitalized patients with cirrhosis and AKI.

Methods: Hospitalized patients with cirrhosis and AKI in the Cerner-Health-Facts database from 1/2009-09/2017 (n = 6,250) were assessed for AKD and were followed-up for 180 days. AKI and AKD were defined based on KDIGO and ADQI AKD and renal recovery consensus criteria, respectively. The primary outcome measure was mortality, and the secondary outcome measure was de novo chronic kidney disease (CKD). Competing-risk multivariable models were used to determine the independent association of AKD with primary and secondary outcomes.

Results: AKD developed in 32% of our cohort. On multivariable competing-risk analysis adjusting for significant confounders, patients with AKD had higher risk of mortality at 90 (subdistribution hazard ratio [sHR] 1.37; 95% CI 1.14-1.66; p = 0.001) and 180 (sHR 1.37; 95% CI 1.14-1.64; p = 0.001) days. The incidence of de novo CKD was 37.5%: patients with AKD had higher rates of de novo CKD (64.0%) compared to patients without AKD (30.7%; p <0.001). After adjusting for confounders, AKD was independently associated with de novo CKD (sHR 2.52; 95% CI 2.01-3.15; p <0.001) on multivariable competing-risk analysis.

Conclusions: AKD develops in 1 in 3 hospitalized patients with cirrhosis and AKI and it is associated with worse survival and de novo CKD. Interventions that target AKD may improve outcomes of patients with cirrhosis and AKI.

Lay summary: In a nationwide US cohort of hospitalized patients with cirrhosis and acute kidney injury, acute kidney disease developed in 1 in 3 patients and was associated with worse survival and chronic kidney disease. Interventions that target acute kidney disease may improve outcomes of patients with cirrhosis and acute kidney injury.

Keywords: acute kidney injury; acute kidney injury recovery; ascites; kidney failure; portal hypertension.

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Conflict of interest statement

Conflicts of interest Dr. Naga Chalasani has ongoing paid consulting activities (or had in preceding 12 months) with Abbvie, Madrigal, Foresite, Galectin, Zydus, and Boehringer-Ingelheim, Altimmune. These consulting activities are generally in the areas of non-alcoholic fatty liver disease and drug hepatotoxicity. Dr. Chalasani receives research grant support from Exact Sciences, DSM, and Galectin Therapeutics where his institution receives the funding. He has equity interest in RestUp, a healthcare staffing start-up company Remaining authors have no disclosures to report. None of the aforementioned disclosures are related to the study. Please refer to the accompanying ICMJE disclosure forms for further details.

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