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

Patidar, Kavish R.; Naved, Mobasshir A; Grama, Ananth; Adibuzzaman, Mohammad; Ali, Arzina Aziz; Slaven, James E.; Desai, Archita P.; Ghabril, Marwan; Nephew, Lauren; Chalasani, Naga; Orman, Eric S.

doi:10.1016/j.jhep.2022.02.009

Cited by 26 publications

(32 citation statements)

References 43 publications

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“…This finding was confirmed on our multivariable competing risk models which included adjustment for the severity of illness, where patients with AKI no-recovery were 2 times at higher risk for mortality compared to patients with recovery. These findings confirm the prognostic significance of AKI norecovery (or AKD) [10] and therefore can be regarded as the "tipping-point" where the risk of mortality is significantly increased in patients with cirrhosis and AKI.…”

Section: Discussionsupporting

confidence: 75%

The prognostic impact of acute kidney injury recovery patterns in critically ill patients with cirrhosis

Worden¹,

Pike²,

Allegretti³

et al. 2023

Liver Transplantation

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Background: The prognostic impact of acute kidney injury (AKI) recovery patterns in critically ill patients with cirrhosis is unknown. We aimed to compare mortality stratified by AKI recovery patterns and identify predictors of mortality in patients with cirrhosis and AKI admitted to the intensive care unit.Materials and Methods: Patients with cirrhosis and AKI from 2016 to 2018 at 2 tertiary care intensive care units were analyzed (N = 322). AKI recovery was defined by Acute Disease Quality Initiative consensus: return of serum creatinine <0.3 mg/dL of baseline within 7 days of AKI onset. Recovery patterns were categorized by Acute Disease Quality Initiative consensus: 0-2 days, 3-7 days, and no-recovery (persistence of AKI > 7 d). Landmark competing risk univariable and multivariable models (liver transplant as competing risk) was used to compare 90-day mortality between AKI recovery groups and to determine independent predictors of mortality. Results: Sixteen percent (N = 50) and 27% (N = 88) achieved AKI recovery within 0-2 and 3-7 days, respectively; 57% (N = 184) had no-recovery.Acute on chronic liver failure was prevalent (83%) and patients with norecovery were more likely to have grade 3 acute on chronic liver failure (N = 95, 52%) compared to patients with AKI recovery [0-2: 16% (N = 8); 3-7: 26% (N = 23); p < 0.001]. Patients with no-recovery had significantly higher probability of mortality [unadjusted-sub-HR (sHR): 3.55; 95% CI: 1.94-6.49; p < 0.001] compared to patients with recovery within 0-2 days, while the probability was similar between 3-7 and 0-2 days (unadjustedsub-HR: 1.71; 95% CI: 0.91-3.20; p = 0.09). On multivariable analysis,

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Section: Discussionsupporting

confidence: 75%

The prognostic impact of acute kidney injury recovery patterns in critically ill patients with cirrhosis

Worden¹,

Pike²,

Allegretti³

et al. 2023

Liver Transplantation

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“…One study showed a significant association between AKI and mortality with infections, hypovolemia due to gastrointestinal bleeding, and refractory ascites as major precipitating factors leading to renal dysfunction [26]. Similarly, patients with cirrhosis and AKI had lower 30-, 90-, and 180-day survival rates compared to patients without an AKI [27,28]. Survival rates were inversely proportional to the stage of AKI [28].…”

Section: Discussionmentioning

confidence: 99%

Outcomes, Mortality, and Cost Burden of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis

Patel

Zhang

Minacapelli

et al. 2023

JGLD

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Background and Aims: Cirrhosis is associated with an increased risk of acute kidney injury (AKI) and hepatorenal syndrome (HRS). Healthcare utilization and cost burden of AKI and HRS in cirrhosis is unknown. We aimed to analyze the health care use and cost burden associated with AKI and HRS in patients with cirrhosis in the United States by using real-world claims data. Methods: We conducted a case-control study using the Truven Health MarketScan Commercial Claims databases from 2007-2017. A total of 34,398 patients with cirrhosis with or without AKI and 4,364 patients with cirrhosis with or without HRS were identified using International Classification of Diseases, Ninth or Tenth Revision, codes and matched 1:1 by sociodemographic characteristics and comorbidities using propensity scores. Total and service-specific were quantified for the 12-months following versus the 12-months before the first date of AKI or HRS diagnosis and over 12-months following a randomly selected date for cirrhosis controls to capture entire disease burdens. Results: The AKI and HRS group had a higher number of comorbidities and were associated with higher rates of readmission and mortality. The AKI and HRS groups had a significantly higher prevalence of ascites, spontaneous bacterial peritonitis (SBP), encephalopathy, gastrointestinal bleeding, septic shock, pulmonary edema, and respiratory failure. Compared to patients with cirrhosis only, AKI was associated with higher number of claims per person (AKI vs. cirrhosis only, 60.30 vs. 47.09; p<0.0001) and total annual median health care costs (AKI vs. cirrhosis only, $46,150 vs. $26,340; p<0.0001). Compared to patients with cirrhosis only, the HRS cohort was associated with a higher number of claims per person (HRS vs. cirrhosis only, 44.96 vs. 43.50; p<0.0009) and total annual median health care costs (HRS vs. cirrhosis only, $34,912 vs. $23,354; p<0.0001). Inpatient costs were higher than the control cohort for AKI (AKI vs. cirrhosis only, $72,720 vs. $29,111; p<0.0001) and HRS (HRS vs. cirrhosis only, $ 98,246 vs. $27,503; p<0.0001). Compared to the control cohort, AKI and HRS had a higher rate of inpatient admission, mean number of inpatient admissions, and mean total length of stay. Conclusions: AKI and HRS are associated with higher health care utilization and cost burden compared to cirrhosis alone, highlighting the importance for improved screening and treatment modalities.

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“…Further, unavailability of linkable patient identifier in the NIS database limited the post-discharge longitudinal outpatient follow up, which would have been relevant in studying impact of HRS on progression to chronic kidney disease and end-stage renal disease. 40 Unavailability of laboratory values and specific HRS treatment received during the hospitalisation limited the assessment of complications and infections and whether these are precipitants of HRS or reflect a higher disease severity. 20 Finally, unavailable data from Veterans Population limits the true generalizability of our study findings to the entire US population.…”

Section: Discussionmentioning

confidence: 99%

“…We were also unable to examine reason for increased use of haemodialysis among HRS hospitalisations during a relatively short period of time from 4.6% in 2016 to 19.3% in 2019, and speculate that this may be due to a greater prevalence of underlying CKD in time, leading to more readily AKI‐HRS on top of CKD leading to initiation of haemodialysis. Further, unavailability of linkable patient identifier in the NIS database limited the post‐discharge longitudinal outpatient follow up, which would have been relevant in studying impact of HRS on progression to chronic kidney disease and end‐stage renal disease 40 . Unavailability of laboratory values and specific HRS treatment received during the hospitalisation limited the assessment of complications and infections and whether these are precipitants of HRS or reflect a higher disease severity 20 .…”

Section: Discussionmentioning

confidence: 99%

Healthcare burden and outcomes of hepatorenal syndrome among cirrhosis‐related hospitalisations in the US

Singal

Kuo

Reddy

et al. 2022

Aliment Pharmacol Ther

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Summary Background Hepatorenal syndrome (HRS) contributes to significant morbidity and mortality in hospitalised patients with cirrhosis. Aims To examine recent trends, magnitude and outcomes of HRS in the National Inpatient Sample (NIS) database Methods Among the NIS database on cirrhosis hospitalisations (2016–2019) due to alcohol (ALD), chronic viral hepatitis (CVH), or NASH and complicated by acute kidney injury (AKI) were analyzed. Results Of 113,454 hospitalisations, 18,735 (16.5%) had HRS (mean age 56 years, 36% females, 68% whites, 80% ALD, 7% NASH) with a stable trend over time. Among 1:1 propensity‐matched 36,090 hospitalisations, the odds of HRS were 12% higher in NASH versus CVH. Based on weighted national estimates, there were 27,180 (8.3 per 100,000 US population) HRS hospitalisations in 2019, with economic burden of $4.2 billion USD. Mean hospitalisation and total charges (ALD vs. CVH vs. NASH) were 11 versus 10.8 versus 9.2 days and 151,000 versus 157,000 versus 120,000 USD, respectively; p < 0.001. In‐hospital mortality was 18.9%, higher in HRS (25.8 vs. 12%, p < 0.001), and decreased by 15% annually. Survivors were more likely to be discharged to short‐ or long‐term care facilities (HRS vs. non‐HRS [42 vs. 27%, p < 0.001]); only 28.7% received palliative care. Conclusion HRS was the cause of AKI in 16.5% of patients hospitalised with cirrhosis and conferred significant healthcare burden with 27,180 HRS hospitalisations in 2019 and requiring an estimated 4.2 billion USD for hospital care. While there has been a decrease in in‐hospital mortality over time, it remained high at 23.7% in 2019 in those with HRS.

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

Cited by 26 publications

References 43 publications

The prognostic impact of acute kidney injury recovery patterns in critically ill patients with cirrhosis

The prognostic impact of acute kidney injury recovery patterns in critically ill patients with cirrhosis

Outcomes, Mortality, and Cost Burden of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis

Healthcare burden and outcomes of hepatorenal syndrome among cirrhosis‐related hospitalisations in the US

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