Article Text

PDF
Acute Kidney Injury and Chronic Kidney Disease in Hospitalized Patients With Cirrhosis
  1. Nafisseh Sirjani Warner, ScM*,
  2. Jennifer A. Cuthbert, MD*,
  3. Rafia Bhore, PhD,
  4. Don C. Rockey, MD*
  1. From the *Division of Digestive and Liver Diseases, Department of Internal Medicine and †Division of Biostatistics, Department of Clinical Sciences University of Texas Southwestern Medical Center and Parkland Memorial Hospital, Dallas, TX.
  1. Received March 27, 2011, and in revised form July 23, 2011.
  2. Accepted for publication July 23, 2011.
  3. Reprints: Don C. Rockey, MD, Division of Digestive and Liver Diseases, UTSW, 5323 Harry Hines Blvd., Dallas, TX 75390-9036. E-mail: don.rockey{at}utsouthwestern.edu.
  4. Author Contributions:
  5. The following are the authors’ contributions to this study: Nafisseh Sirjani Warner—study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and statistical analysis; Jennifer Cuthbert—study concept and design, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content; Rafia Bhore—analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and statistical analysis; and Don Rockey—study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.
  6. Authors’ Declaration of Personal Interests:
  7. This study was supported in part by the Doris Duke Charitable Foundation (Clinical Research Fellowship to N.S.W.). The authors certify that we have no financial arrangements (eg, consultancies, stock ownership, equity interests, patent-licensing arrangements, research support, major honoraria) with a company whose product figures prominently in this manuscript or with a company making a competing product.

Abstract

Background Renal dysfunction is a common and potentially life-threatening complication in hospitalized patients with cirrhosis.

Aims To determine the prevalence, cause, and outcome of patients with cirrhosis and acute kidney injury (AKI) and/or chronic kidney disease (CKD).

Methods This retrospective analysis examined hospital records of 152 consecutive patients with cirrhosis and creatinine levels of 1.5 mg/dL or greater. Multiple clinical and laboratory variables were abstracted for each subject. Precise definitions were used to define cirrhosis and etiologies of renal dysfunction. Univariate and multivariable logistic regression analyses were performed to identify features with prognostic value for hospital mortality.

Results The most common type of renal dysfunction was AKI, present in 107 patients (70%). Acute kidney injury plus CKD was found in 26 patients (17%), and CKD alone was present in 19 patients (13%). Prerenal azotemia was the most common cause of AKI (69%), often occurring secondary to gastrointestinal hemorrhage. The overall mortality for the cohort was 31%, with the highest mortality occurring in patients with type 1 hepatorenal syndrome (HRS) (11/14, 79%). We were unable to identify any patient meeting diagnostic criteria for type 2 HRS. The development of AKI on preexisting CKD did not infer worse prognosis than AKI alone. The presence of upper gastrointestinal bleeding, bacteremia, and HRS-1 predicted mortality.

Conclusions Both AKI and CKD are common in hospitalized patients with cirrhosis, often occurring simultaneously. Type 2 HRS was not identified, suggesting that its diagnostic criteria may need reevaluation or that this syndrome may not represent a unique functional kidney disorder.

Key Words
  • creatinine
  • liver
  • renal dysfunction
  • hepatorenal syndrome
  • outcome
  • MELD

Statistics from Altmetric.com

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.