Impact of acute kidney injury on the risk of mortality in patients with cirrhosis: a systematic review and meta-analysis

Yun-feng, Ning; Zou, Xiaoyue; Xu, Jing; Wang, Xiao; Ding, Min; Lu, Hulin

doi:10.1080/0886022x.2022.2142137

Cited by 13 publications

(12 citation statements)

References 61 publications

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“…More recently, Ning et al . [15] included 32 studies in their analysis of short and long-term mortality risk of AKI in cirrhosis and found consistent results with previous findings. The highest risk was reported to inhospital mortality at which AKI increased the mortality by 5.92-folds [15].…”

Section: Introductionsupporting

confidence: 71%

“…The results showed that inhospital mortality, and mortality at 30 days, 3 months, or at 1-year follow-up were considerably higher in cirrhosis patients with AKI [5]. More recently, Ning et al [15] included 32 studies in their analysis of short and long-term mortality risk of AKI in cirrhosis and found consistent results with previous findings. The highest risk was reported to inhospital mortality at which AKI increased the mortality by 5.92-folds [15].…”

Section: Introductionsupporting

confidence: 63%

“…Although cirrhosis patients are at high risk for developing AKI in outpatient settings before hospital admission, most of the former studies focused on outcomes of AKI that occurred during hospitalization with decompensated cirrhosis [15]. Also, only a few global studies evaluated the economic burden of AKI in cirrhosis [12,13,16,17].…”

Section: Introductionmentioning

confidence: 99%

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Acute kidney injury development and impact on clinical and economic outcomes in patients with cirrhosis: an observational cohort study over a 10-year period

Alshogran

Altawalbeh

Al-Mestarihi

2023

European Journal of Gastroenterology &Amp; Hepatology

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Objectives Acute kidney injury (AKI) is a severe complication that is associated with significant morbidity and mortality in hospitalized cirrhotic patients. Data about AKI incidence and outcomes in patients with cirrhosis is scarce in the Middle East region. This study explored the incidence and impact of AKI on clinical and economic outcomes in cirrhosis. Methods This was a retrospective cohort study of cirrhosis patients admitted to an educational hospital in Jordan during the years 2012-2022. Demographics, clinical and biochemical information, and charges were retrieved from medical electronic records. Logistic regression models were conducted to evaluate predictors of AKI and mortality in cirrhosis adjusting for covariates. Hospital charges were also described. Results A total of 380 cirrhosis patients were included with an AKI incidence of 27.9%. Male sex, elevated baseline serum creatinine, presence of spontaneous bacterial peritonitis, and higher comorbidity score were independently associated with AKI development (P < 0.05). The hospital mortality rate was markedly higher for patients with AKI versus those without AKI (51.9% vs. 6.2%, respectively; P < 0.001). AKI was associated independently with higher odds of hospital death (OR = 5.83, P < 0.001), prolongation of the median hospital stays by 5 days (P < 0.001), more clinical complications, and increased total hospital charges per admission by $2500. Conclusion AKI is prevalent in cirrhosis patients, and it is associated with increased mortality, hospitalization, and cost. This burden in cirrhosis emphasizes the need for early identification of patients at high risk of AKI and applying prompt and effective management approaches, aiming at improving outcomes.

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Section: Introductionsupporting

confidence: 71%

Section: Introductionsupporting

confidence: 63%

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Acute kidney injury development and impact on clinical and economic outcomes in patients with cirrhosis: an observational cohort study over a 10-year period

Alshogran

Altawalbeh

Al-Mestarihi

2023

European Journal of Gastroenterology &Amp; Hepatology

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“…Perhaps performing an IVC US to assess intravascular volume before, during and/or after administering the standardized volume therapy with discontinuation of diuretic therapy, would be beneficial to avoid prolonging hypovolemia or inducing hypervolemia, and may improve clinical outcomes. Decreasing the risk or severity of AKI may potentially reduce the morbidity and mortality in patients with cirrhosis [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review and meta-analysis by Ning et al. [ 3 ], indicates that the presence of AKI in patients with cirrhosis is significantly associated with higher mortality in-hospital (OR 5.92), at 30 days (OR 4.78), and at 1 year follow-up (OR 4.82) compared to patients without AKI. In these patients, increasing risk of mortality is correlated with an increase in the stage of AKI.…”

Section: Introductionmentioning

confidence: 99%

Hepatorenal syndrome misdiagnosis may be reduced using inferior vena cava ultrasound to assess intravascular volume and guide management

Kaptein

2023

Renal Failure

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Hepatorenal syndrome (HRS) is a diagnosis of exclusion defined as acute kidney injury (AKI) with cirrhosis and ascites, with serum creatinine unresponsive to standardized volume administration and diuretic withdrawal. Persistent intravascular hypovolemia or hypervolemia may contribute to AKI and be revealed by inferior vena cava ultrasound (IVC US), which may guide additional volume management. Twenty hospitalized adult patients meeting HRS-AKI criteria had IVC US to assess intravascular volume after receiving standardized albumin administration and diuretic withdrawal. Six had IVC collapsibility index (IVC-CI) ≥50% and IVCmax ≤0.7 cm suggesting intravascular hypovolemia, 9 had IVC-CI <20% and IVCmax >0.7 cm suggesting intravascular hypervolemia, and 5 had IVC-CI ≥20% to <50% and IVCmax >0.7 cm. Additional volume management was prescribed in the 15 patients with either hypovolemia or hypervolemia. After 4–5 days, serum creatinine levels decreased ≥ 20% without hemodialysis in 6 of 20 patients – 3 with hypovolemia received additional volume, and 2 with hypervolemia plus one with ‘euvolemia’ and dyspnea were volume restricted and received diuretics. In the other 14 patients, serum creatinine failed to persistently decrease ≥20% or hemodialysis was required indicating that AKI did not improve. In summary, fifteen of 20 patients (75%) were presumed to have intravascular hypovolemia or hypervolemia by IVC ultrasound. Six of the 20 patients (40%) improved AKI by 4-5 days of follow-up with additional IVC US-guided volume management, and thus had been misdiagnosed as HRS-AKI. IVC US may more accurately define HRS-AKI as being neither hypovolemic nor hypervolemic, and guide volume management, decreasing the frequency of HRS-AKI misdiagnosis.

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Acute kidney injury development is associated with mortality in Japanese patients with cirrhosis: impact of amino acid imbalance

Miwa,

Utakata,

Hanai

et al. 2024

J Gastroenterol

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Background Acute kidney injury (AKI) is a serious complication of cirrhosis. This study analyzed the prognostic effect of AKI in patients with cirrhosis and its risk factors, particularly in relation to amino acid imbalance. Methods This retrospective study reviewed 808 inpatients with cirrhosis at two institutes in Gifu, Japan. AKI was diagnosed according to the recommendations of the International Club of Ascites. Amino acid imbalance was assessed by measuring serum branched-chain amino acid (BCAA) levels, tyrosine levels, and the BCAA-to-tyrosine ratio (BTR). Factors associated with mortality and AKI development were assessed using the Cox proportional hazards regression model with AKI as a time-dependent covariate and the Fine–Gray competing risk regression model, respectively. Results Of the 567 eligible patients without AKI at baseline, 27% developed AKI and 25% died during a median follow-up period of 4.7 years. Using a time-dependent covariate, AKI development (hazard ratio [HR], 6.25; 95% confidence interval [CI], 3.98–9.80; p < 0.001) was associated with mortality in patients with cirrhosis independent of potential covariates. In addition, alcohol-associated/-related liver disease, metabolic dysfunction-associated steatohepatitis, Child–Pugh score, and BTR (subdistribution HR 0.78; 95% CI 0.63–0.96; p = 0.022) were independently associated with AKI development in patients with cirrhosis. Similar results were obtained in the multivariate model that included BCAA and tyrosine levels instead of BTR. Conclusions AKI is common and associated with mortality in Japanese patients with cirrhosis. An amino acid imbalance is strongly associated with the development of AKI in patients with cirrhosis.

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Impact of acute kidney injury on the risk of mortality in patients with cirrhosis: a systematic review and meta-analysis

Cited by 13 publications

References 61 publications

Acute kidney injury development and impact on clinical and economic outcomes in patients with cirrhosis: an observational cohort study over a 10-year period

Acute kidney injury development and impact on clinical and economic outcomes in patients with cirrhosis: an observational cohort study over a 10-year period

Hepatorenal syndrome misdiagnosis may be reduced using inferior vena cava ultrasound to assess intravascular volume and guide management

Acute kidney injury development is associated with mortality in Japanese patients with cirrhosis: impact of amino acid imbalance

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