Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the International Club of Ascites

Angeli, Paolo; Ginès, Pere; Wong, Florence; Bernardi, Mauro; Boyer, Thomas D.; Gerbes, Alexander L.; Moreau, Richard; Jalan, Rajiv; Sarin, Shiv Kumar; Piano, Salvatore; Moore, Kevin; Lee, Samuel S.; Durand, François; Salerno, Francesco; Caraceni, Paolo; Kim, Woojin; Arroyo, Vicente; García–Tsao, Guadalupe

doi:10.1016/j.jhep.2014.12.029

Cited by 677 publications

(760 citation statements)

References 32 publications

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“…Other outcomes examined included severity of disease, evolution of disease assessed by change in bilirubin over the first 7 days of admission, morbidity (length of hospital admission, and incidence of renal failure, defined as per recent expert consensus [12]) and mortality. Data was extracted from completed questionnaires into a pre-prepared spreadsheet to allow for analysis.…”

Section: Methodsmentioning

confidence: 99%

Alcohol, Diet and Drug Use Preceding Alcoholic Hepatitis

Parker

Neuberger

2018

Dig Dis

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Background: Alcoholic hepatitis (AH) is a severe manifestation of alcohol-related liver disease characterised by jaundice and liver failure. It is not known what might trigger an episode of AH. We interviewed patients to investigate changes in behaviour before the onset of AH. Methods: Structured interviews were performed with patients with AH to examine their alcohol use, diet, drug use and smoking habit. Clinical and laboratory results were noted. Patients were followed up for 12 months after interview. Results: Data from 39 patients was analysed. No single behavioural change occurred before the onset of jaundice, although reductions in alcohol and/or dietary intake were common. Reduction in alcohol use was seen to occur approximately 14 days before the onset of jaundice. Increased alcohol intake was not common. Clinical and laboratory data varied between types of behaviour changes, although these were not statistically significant. No changes in drug use or tobacco were reported before AH. Those who had not reduced alcohol intake or had increased their drinking had better survival. Conclusions: No single type of behaviour change is associated with AH. Contrary to previous assertions, increased alcohol intake was not common; in fact, participants were much more likely to have reduced their alcohol intake.

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Section: Methodsmentioning

confidence: 99%

Alcohol, Diet and Drug Use Preceding Alcoholic Hepatitis

Parker

Neuberger

2018

Dig Dis

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“…The incidence and the prevalence of HRS in patients with advanced liver disease are approximately 7.6% and 13%, respectively (2). HRS occurs predominantly in portal hypertension associated with cirrhosis, but it has been described in severe alcoholic hepatitis and fulminant hepatic failure (3).…”

Section: Epidemiologymentioning

confidence: 99%

“…Recent consensus guidelines have been published by the International Club of Ascites (ICA) updating the recommended threshold for diagnosing AKI in patients with cirrhosis (Table 1), which now align with the Kidney Disease Improving Global Outcomes (KDIGO) AKI classification (2). HRS is a diagnosis of exclusion and should be suspected in patients presenting with new renal impairment in the setting of cirrhosis with ascites.…”

Section: Diagnostic Criteriamentioning

confidence: 99%

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An Update on Hepatorenal Syndrome

Chan¹,

Francis³

et al. 2017

jrenhep

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Hepatorenal syndrome (HRS) is one of the many potential causes of acute kidney injury (AKI) in patients with decompensated liver disease. HRS is associated with poor prognosis and represents the end-stage of a sequence of reductions in renal perfusion induced by progressively severe hepatic injury. The pathophysiology of HRS is complex with multiple mechanisms interacting simultaneously, although HRS is primarily characterised by renal vasoconstriction. A recently revised diagnostic criteria and management algorithm for AKI has been developed for patients with cirrhosis, allowing physicians to commence treatment promptly. Vasopressor therapy and other general management, such as antibiotic prophylaxis, need to be initiated whilst patients are assessed for eligibility for transplantation. Liver transplantation remains the treatment of choice for HRS but is limited by organ shortage. Other management options, such as transjugular intrahepatic portosystemic shunt, renal replacement therapy and molecular absorbent recirculating system, may provide short-term benefit for patients not responding to medical therapy whilst awaiting transplantation. Clinicians need to be aware of the pathophysiology and management principles of HRS to provide quality care for patients with multi-organ failure.

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“…With the improved understanding of renal failure in cirrhosis, the definition of renal failure has been challenged. Recently, a working group composed of members of the International Ascites Club (IAC) and the Acute Dialysis Quality Initiative (ADQI) reached the final proposal for the diagnosis of cirrhosis-AKI, named IAC-AKI, which is defined that any patients with cirrhosis and an increase in serum creatinine (sCr) by either 26.5µmol/L within 48 h or by 50% from baseline within 7 days, would be classified as having AKI, abandoning the threshold of sCr ≥133 µmol/L in the traditional criteria [5]. …”

Section: Introductionmentioning

confidence: 99%

Evaluation of Absolute Serum Creatinine Changes in Staging of Cirrhosis-Induced Acute Renal Injury and its Association with Long-term Outcomes

Zhou¹,

Luo²,

Lv³

et al. 2017

Kidney Blood Press Res

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Background/Aims: To assess the prognostic accuracy of absolute serum creatinine (sCr) changes (‘Delta-sCr’) on the long-term outcomes in cirrhotic patients, and evaluate the performance of the ‘Delta-sCr’ approach to stage acute kidney injury (AKI), compared with the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Methods: We conducted a retrospective analysis of 333 hospitalized patients. We classified AKI stages using two methods: 1) KDIGO AKI criteria; 2) ‘Delta-sCr’ system, defined by the difference between the baseline and the peak sCr value during the hospitalization. The end point was the hazard of 1-year death. Results: The prevalence of AKI in cirrhotic patients was 18.01% by the KDIGO criteria, and 25.22% by the ‘Delta-sCr’ system. On multivariable Cox hazard analysis, both of the two methods were independent predictive factors of death (‘Delta-sCr’ system: OR=2.911, p<0.001), (KDIGO criteria: OR=2.065, p<0.001). However, the ‘Delta-sCr’ system provided a modest improvement in classification over the KDIGO criteria with a net reclassification improvement (NRI) of 28.7% (p<0.001) and integrated discrimination improvement (IDI) of 7.5% (p=0.03). And the predictive value of the ‘Delta-sCr’ system could be significantly improved (p=0.006), when combined with age and MELD score. Conclusion: The Delta-sCr is associated with the 1-year mortality. And the ‘Delta-sCr’ system may optimize the discrimination of risk prediction.

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Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the International Club of Ascites

Cited by 677 publications

References 32 publications

Alcohol, Diet and Drug Use Preceding Alcoholic Hepatitis

Alcohol, Diet and Drug Use Preceding Alcoholic Hepatitis

An Update on Hepatorenal Syndrome

Evaluation of Absolute Serum Creatinine Changes in Staging of Cirrhosis-Induced Acute Renal Injury and its Association with Long-term Outcomes

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