January 15, 2020
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CKD following acute kidney injury impairs cirrhosis clinical outcomes

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Development of chronic kidney disease following acute kidney injury in patients with cirrhosis was common and had negative impacts on relevant clinical outcomes, according to a data published in Journal of Hepatology.

“Acute impairment of kidney function occurs very commonly in patients with decompensated cirrhosis and is associated with poor prognosis,” Pere Ginès, MD, from the Hospital Clinic at the University of Barcelona, Spain, and colleagues wrote. “In recent years, a new definition and diagnostic criteria for acute impairment of kidney function, known as Acute Kidney Injury (AKI), has emerged. The appearance of [the] AKI concept has been a major step forward in the diagnosis of acute impairment of kidney function in clinical practice and has stimulated the research in this field.”

The study included 409 patients, 168 of whom had AKI at admission or developed AKI during hospitalization. After 3 months of follow-up, the AKI group comprised only 97 participants (58 had died, 8 had been transplanted and 5 were lost to follow-up). Twenty-four of those patients developed CKD with a median estimated glomerular filtration rate of 47 mL per min/1.72 m2, whereas only two of the 188 patients without AKI developed CKD during the same time frame (P < .0001).

Kidney function impairment progressed during follow-up in six patients, indicated by an increase in the stage of CKD. Specifically, four patients progressed to stage 3B CKD and two to stage 4, with one patient requiring hemodialysis.

Multivariate analysis showed that nosocomial AKI (OR = 5.1; 95% CI, 1.7-15.2) and AKI stage 1B or higher (OR = 6; 95% CI, 1.7-21.2) correlated independently with CKD development.

Development of CKD correlated with increased risks for AKI during follow-up with higher rates of new episodes of AKI in patients with CKD than those without (75% vs. 45%; P = .011). Additionally, patients with CKD had higher rates of ascites (54% vs. 25%; P = .007), refractory ascites (25% vs. 7%; P = .015), bacterial infections (58% vs. 34%; P = .037), and readmission at 3 months (67% vs. 37%; P = .011).

Ginès and colleagues emphasized that none of the patients enrolled had CKD before admission and that rate of CKD development in patients hospitalized for decompensated cirrhosis without AKI was extremely low at 1%. What the study highlights, however, is that transition from AKI to CKD in patients with cirrhosis led to impaired clinical outcomes.

“The current findings extend these observations to patients with cirrhosis and indicate that patients with cirrhosis and CKD should be considered a high risk group for development of AKI,” they concluded. – by Talitha Bennett

Disclosures: Ginès reports investigator research grant or advisory board work from Grífols, Gilead, Mallinckrodt, Promethera, Martin Pharmaceuticals, Ferring Pharmaceuticals, and Sequana. Please see the full study for all other authors’ relevant financial disclosures.