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:10.1136/gutjnl-2014-308874

Cited by 624 publications

(988 citation statements)

References 36 publications

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“…Some experts suggest that patients with a new onset elevation in creatinine, even below the 1.5 mg/dl threshold, who do not respond to the removal of risk factors and plasma volume expansion might benefit from more intensive medical treatment. Namely, vasopressors as for hepatorenal syndrome could be used, although it remains unclear if these "renal prophylactic" measures are beneficial (21). Clearly, in this setting not only organ support is important, but also prevention of further organ dysfunction.…”

Section: Discussionmentioning

confidence: 99%

CLIF-C ACLF score is a better mortality predictor than MELD, MELD-Na and CTP in patients with Acute on Chronic Liver Failure admitted to the ward

et al. 2017

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Background and aims: Acute-on-chronic liver failure (ACLF) is a frequent syndrome associated with high mortality. The aims of the present study are: a) comparing the Chronic Liver Failure Consortium (CLIF-C) ACLF Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na) and Child-TurcottePugh (CTP) scores for prediction of short/medium term mortality; b) identifying ACLF prevalence in patients admitted to the ward; and c) comparing mortality between non-ACLF/ACLF.Methods: Retrospective cohort study of 177 patients admitted to the Gastroenterology ward for acute decompensation of cirrhosis.Results: We included 132 males. Alcohol was the cirrhosis cause/co-factor in 79.7% of cases. Infection was present in 40.7%. At admission, 19.8% of patients presented ACLF and 7.9% developed it during hospitalization (overall prevalence was 27.7%). ACLF grade 1 was diagnosed in 55.1% of the ACLF patients; grade 2, in 42.8%, and grade 3, in 2.0%. Infection (p < 0.001) and hepatic encephalopathy (p = 0.004) were more prevalent and C-reactive protein and leukocyte counts were higher in ACLF patients. ACLF 28 and 90-day mortality was 45.8% and 60.4%, respectively. The CLIF-C ACLF score was significantly superior to CTP, MELD, MELD-Na in predicting 28-day (AUROC 0.799 ± 0.078, 95% CI 0.637-0.891) and 90-day mortality (AUROC 0.828 ± 0.063, 95% CI 0.705-0.952).Conclusion: ACLF is highly prevalent in the ward. The new CLIF scores identify high mortality cirrhotic patients admitted to the ward and are better than their predecessors to predict ACLF patients' short/medium term mortality.

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Section: Discussionmentioning

confidence: 99%

CLIF-C ACLF score is a better mortality predictor than MELD, MELD-Na and CTP in patients with Acute on Chronic Liver Failure admitted to the ward

et al. 2017

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“…2). 39 Management of AKI in cirrhosis includes (1) identification and treatment of precipitants such as infection or hypovolemia; (2) withdrawal of diuretics and nephrotoxic drugs; and (3) use of vasoconstrictor medications to correct peripheral vasodilatation if HRS is suspected. Although terlipressin is widely used, it is not yet licensed in the United States.…”

Section: Renal Failurementioning

confidence: 99%

Keeping high model for end‐stage liver disease score liver transplantation candidates alive

et al. 2015

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“…The former may have shown how many patients met the new International Ascites Club. 9,10 These definitions may be relevant because the same group had found that the treatment of either type 1 HRS or type 2 HRS with a mean sCr of 2.7 mg/dL and a measured GFR <40 mL/minute had a positive impact on survival and renal outcomes after LT. 3 In addition, not knowing the time between diagnosis of type 2 HRS and the start of the treatment or the time between the diagnosis of type 2 HRS and LT limits our ability to speculate how long type 2 HRS can remain "functional renal failure" and potentially be reversible after LT. Indeed, missing variables could have contributed to the development and/or the worsening of some degree of kidney parenchymal damage 11 whose presence could not be suspected by eGFR as well as completely excluded by the absence of proteinuria, hematuria, or abnormalities on renal ultrasonography.…”

Section: See Article On Page 1347mentioning

confidence: 99%

Is type 2 hepatorenal syndrome still a potential indication for treatment with terlipressin and albumin?

Angeli

Piano

2015

Liver Transpl

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The question is deliberately provocative. However, if we reflect on the data about the treatment with terlipressin and albumin of type 2 hepatorenal syndrome (HRS), we have to recognize that despite a good response rate, there is a frustrating rate of recurrence. 1 In addition, despite some anecdotal pioneering approaches, 2 terlipressin remains a drug for use only in inpatients where available. We, therefore, need to recognize that the only indication for treating type 2 HRS for a patient who is a candidate for liver transplantation (LT) is to improve posttransplant outcomes, 3,4 at least in those countries in which a specific prioritization policy for LT has been developed in relation to HRS and its treatment. 5 In patients with potentially reversible renal dysfunction, such as type 2 HRS, predicting whether there will be sufficient return of native kidney function is sometimes difficult. Nevertheless, it has been established that the phenotype of acute kidney injury (AKI) at the time of LT has a great impact on patient survival and renal outcomes after LT, 6,7 with both being worse at 1 and 5 years after LT for acute tubular necrosis (ATN) compared to those with HRS. At 5 years, the prevalence of chronic kidney disease (CKD; stage 4 or 5) was significantly higher in the ATN group compared to the HRS group (56% versus 16%; P < 0.001). 6 There is little information on the effects of treatment with vasoconstrictors plus albumin in patients with HRS awaiting LT on the outcomes after LT, either in terms of survival or renal outcomes.In this issue of Liver Transplantation, Rodriguez et al. 8 reports the effects of treatment of type 2 HRS in LT candidates. The most notable finding was that an increase in glomerular filtration rate (GFR) in patients who had type 2 HRS before LT did not offer any significant advantage after LT. Importantly, there were no significant differences between patients with or without reversal of type 2 HRS before LT in relation to the development of AKI, renal replacement therapy, a change in serum creatinine (sCr) or in estimated glomerular filtration rate (eGFR) over time, or to the development of CKD by 1 year after LT. 8 Before we discuss the potential reasons for this therapeutic failure, it should be pointed out that this retrospective study was performed at a single, very valuable center in Spain. This observation is important because, as highlighted by Rodriguez et al. 8 in the discussion, the study was performed under 2 conditions that reduced the time to LT for patients with type 2 HRS, namely, (1) a very high rate of organ donation and (2) as of 2007, a priority allocation system in the waiting list that used the maximum value of sCr reached in Model for End-Stage Liver Disease (MELD) score updates for patients with HRS, which was to avoid a reduction of MELD after HRS reversal. By reducing the waiting time for LT in patients with type 2 HRS regardless of whether they were treated or how they responded, this could have masked any

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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 624 publications

References 36 publications

CLIF-C ACLF score is a better mortality predictor than MELD, MELD-Na and CTP in patients with Acute on Chronic Liver Failure admitted to the ward

CLIF-C ACLF score is a better mortality predictor than MELD, MELD-Na and CTP in patients with Acute on Chronic Liver Failure admitted to the ward

Keeping high model for end‐stage liver disease score liver transplantation candidates alive

Is type 2 hepatorenal syndrome still a potential indication for treatment with terlipressin and albumin?

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