Citations 2
Association of Hepatorenal Syndrome-Acute Kidney Injury with Mortality in Patients with Cirrhosis Requiring Renal Replacement Therapy
Cama-Olivares, Augusto , Ouyang, Tianqi , Takeuchi, Tomonori , Hillien, Shelsea A. St., Robinson, Jevon E. , Cullaro, Giuseppe , Karvellas, Constantine , Levitsky, Josh , Orman, Eric S. , Patidar, Kavish R. , Regner, Kevin R. , Saly, Danielle L. , Teixeira, J. Pedro , Velez, Juan Carlos Q. , Wahid, Nabeel , Allegretti, Andrew S. , Neyra, Javier A. , Belcher, Justin M. , Cullaro, Giuseppe , Karvellas, Constantine , Orman, Eric S , Sawinski, Deirdre , Teixeira, J Pedro , Ufere, Nneka N , Velez, Juan Carlos Q , Wadei, Hani M , Wahid, Nabeel , Neyra, Javier A , Belcher, Justin M , Patidar, Kavish R , Chung, Raymond T. , Sharma, Pratima , Wadei, Hani M.
Kidney360 | September 30, 2024 | Volume: 6 | Issue: 2 | Pages: 247-256
Key Points In patients with cirrhosis and AKI requiring renal replacement therapy (RRT), hepatorenal syndrome-AKI was not associated with an increased 90-day mortality when compared with other AKI etiologies. Etiology of AKI may not be a critical factor regarding decisions to trial RRT in acutely ill patients with cirrhosis and AKI. Although elevated, mortality rates in this study are comparable with those reported in general hospitalized patients with AKI requiring RRT. Background While AKI requiring renal replacement therapy (AKI-RRT) is associated with increased mortality in heterogeneous inpatient populations, the epidemiology of AKI-RRT in hospitalized patients with cirrhosis is not fully known. Herein, we evaluated the association of etiology of AKI with mortality in hospitalized patients with cirrhosis and AKI-RRT in a multicentric contemporary cohort. Methods This is a multicenter retrospective cohort study using data from the HRS-HARMONY consortium, which included 11 US hospital network systems. Consecutive adult patients admitted in 2019 with cirrhosis and AKI-RRT were included. The primary outcome was 90-day mortality, and the main independent variable was AKI etiology, classified as hepatorenal syndrome (HRS-AKI) versus other (non–HRS-AKI). AKI etiology was determined by at least two independent adjudicators. We performed Fine and Gray subdistribution hazard analyses adjusting for relevant clinical variables. Results Of 2063 hospitalized patients with cirrhosis and AKI, 374 (18.1%) had AKI-RRT. Among them, 65 (17.4%) had HRS-AKI and 309 (82.6%) had non–HRS-AKI, which included acute tubular necrosis in most cases (62.6%). Continuous renal replacement therapy was used as the initial modality in 264 (71%) of patients, while intermittent hemodialysis was used in 108 (29%). The HRS-AKI (versus non–HRS-AKI) group received more vasoconstrictors for HRS management (81.5% versus 67.9%), whereas the non–HRS-AKI group received more mechanical ventilation (64.3% versus 50.8%) and more continuous renal replacement therapy (versus intermittent hemodialysis) as the initial RRT modality (73.9% versus 56.9%). In the adjusted model, HRS-AKI (versus non–HRS-AKI) was not independently associated with increased 90-day mortality (subdistribution hazard ratio, 1.36; 95% confidence interval, 0.95 to 1.94). Conclusions In this multicenter contemporary cohort of hospitalized adult patients with cirrhosis and AKI-RRT, HRS-AKI was not independently associated with an increased risk of 90-day mortality when compared with other AKI etiologies. The etiology of AKI appears less relevant than previously considered when evaluating the prognosis of hospitalized adult patients with cirrhosis and AKI requiring RRT.
Outcomes of patients with alcohol‐associated hepatitis and acute kidney injury – Results from the HRS Harmony Consortium
T., Ann , Allegretti, Andrew S. , Cullaro, Giuseppe , Ouyang, Tianqui, Asrani, Sumeet K. , Przybyszewski, Eric M. , Robinson, Jevon E., Wadei, Hani M. , Hillien, Shelsea A. St., Saly, Danielle L. , Dageforde, Leigh Anne , Regner, Kevin R. , Belcher, Justin M. , Patidar, Kavish R. , Ma, Ann T , Ufere, Nneka N , Patidar, Kavish R , Asrani, Sumeet K , Wadei, Hani M , Cullaro, Giuseppe , Chung, Raymond T. , Wilechansky, Robert M. , Sharma, Pratima , Simonetto, Douglas A. , Jalal, Prasun K. , Orman, Eric S.
Alimentary Pharmacology & Therapeutics | July 16, 2024 | Volume: 60 | Issue: 6 | Pages: 778-786
Summary Background & Aims The development of acute kidney injury (AKI) in the setting of alcohol‐associated hepatitis (AH) portends a poor prognosis. Whether the presence of AH itself drives worse outcomes in patients with cirrhosis and AKI is unknown. Methods Retrospective cohort study of 11 hospital networks of consecutive adult patients admitted in 2019 with cirrhosis and AKI. AKI phenotypes, clinical course, and outcomes were compared between AH and non‐AH groups. Results A total of 2062 patients were included, of which 303 (15%) had AH, as defined by National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria. Patients with AH, compared to those without, were younger and had higher Model for End‐stage Liver Disease‐Sodium (MELD‐Na) scores on admission. AKI phenotypes significantly differed between groups ( p < 0.001) with acute tubular necrosis occurring more frequently in patients with AH. Patients with AH reached more severe peak AKI stage, required more renal replacement therapy, and had higher 90‐day cumulative incidence of death (45% [95% CI: 39%–51%] vs. 38% [95% CI: 35%–40%], p = 0.026). Using no AH as reference, the unadjusted sHR for 90‐day mortality was higher for AH (sHR: 1.24 [95% CI: 1.03–1.50], p = 0.024), but was not significant when adjusting for MELD‐Na, age and sex. However, in patients with hepatorenal syndrome, AH was an independent predictor of 90‐day mortality (sHR: 1.82 [95% CI: 1.16–2.86], p = 0.009). Conclusions Hospitalised patients with cirrhosis and AKI presenting with AH had higher 90‐day mortality than those without AH, but this may have been driven by higher MELD‐Na rather than AH itself. However, in patients with hepatorenal syndrome, AH was an independent predictor of mortality.