Acute kidney injury in hospitalized cirrhotic patients: Risk factors, type of kidney injury, and survival

Abstract

Background and AimAcute kidney injury (AKI) is a common complication of chronic liver disease (CLD). We performed a prospective study to evaluate the risk factors and spectrum of AKI among decompensated cirrhosis (DC) patients and the impact of AKI on survival.MethodsThis study was conducted in consecutive DC patients hospitalized in SCB Medical College between December 2016 and October 2018. AKI was defined as per ICA criteria. Demographic, clinical, and laboratory parameters and outcomes were compared between patients with and without AKI.ResultsA total of 576 DC subjects were enrolled, 315 (54.69%) of whom had AKI; 34% (n = 106) had stage 1A, 28% (n = 90) stage 1B, 21% (n = 65) stage 2, and 17% (n = 54) stage 3 AKI. Alcohol was the predominant cause of CLD (66.7%). In 207 (65.7%) patients, diuretic/lactulose/nonsteroidal anti‐inflammatory drugs use was noted, and infection was present in 190 (60.3%) patients. Compared to those without AKI, patients with AKI had higher leucocyte count, higher serum urea and creatinine, higher Child‐Turcotte‐Pugh, higher Model of End‐Stage Liver Disease (MELD) scores (P < 0.001), longer hospital stay, and lower survival at 28 days and 90 days (P < 0.001). Besides, in patients with stages 1A to 3 AKI, there were differences in overall survival at 28 days (P < 0.001) and 90 days (P < 0.001).ConclusionsOver half of DC patients had AKI, and alcohol was the most common cause of cirrhosis in them. Use of AKI‐precipitating medications was the most common cause of AKI, followed by bacterial infection. AKI patients had increased prevalence of acute‐on‐chronic liver failure and had prolonged hospitalization and lower survival both at 28 days and 90 days.

Development and validation of a nomogram for predicting overall survival in cirrhotic patients with acute kidney injury

“…Currently, many studies have investigated risk factors for mortality in patients with cirrhosis[ 10 ] and other complications, such as gastroesophageal variceal bleeding[ 11 , 12 ], ascites[ 13 ], bacterial infections[ 14 ] and metabolic acidosis[ 15 ]. Moreover, a number of studies have focused on identifying the risk factors for the development of AKI in patients with cirrhosis[ 16 - 19 ] and other conditions[ 20 - 22 ]. Furthermore, numerous studies have also evaluated the effect of AKI on the mortality of patients with cirrhosis[ 16 , 23 - 25 ].…”

Evaluation of Serum Kidney Injury Markers FABP1, NGAL, Cystatin C and the Inflammatory Cytokine IL-18 in the Detection of Acute-on-Chronic Liver Failure (ACLF) Associated Acute Kidney Injury (AKI)

“…The occurrence of AKI signi cantly increases the risk of mortality in ACLF patients [10,11,12]. Hence, prediction and management of AKI in ACLF is a priority.…”

Risk and protective factors of acute kidney injury in decompensated cirrhotic patients with ascites on tolvaptan

“…7 The use of AKI-precipitating medications was reported to be the most common cause of AKI, followed by bacterial infection, including spontaneous bacterial peritonitis (SBP). 8 The recommended treatment for cirrhosis has been updated in the Clinical Practice Guidelines for Decompensated Cirrhosis proposed by the European Association for the Study of the Liver (EASL) in 2018. 9 The Japanese Society of Gastroenterology and the Japan Society of Hepatology also revised the guidelines for the treatment of cirrhosis in 2020.…”

“…High portal pressure and severe vasodilatation predispose patients with cirrhosis to increased risk of AKI and chronic kidney disease (CKD) 7 . The use of AKI‐precipitating medications was reported to be the most common cause of AKI, followed by bacterial infection, including spontaneous bacterial peritonitis (SBP) 8 …”