Acute kidney injury and chronic kidney disease in hospitalized patients with cirrhosis

Nafisseh Sirjani Warner, Jennifer A. Cuthbert, Rafia Bhore, Don C. Rockey

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Renal dysfunction is a common and potentially lifethreatening 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 andmultivariable 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.

Original languageEnglish (US)
Pages (from-to)1244-1251
Number of pages8
JournalJournal of Investigative Medicine
Volume59
Issue number8
DOIs
StatePublished - Dec 2011

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Chronic Renal Insufficiency
Acute Kidney Injury
Fibrosis
Hepatorenal Syndrome
Kidney
Mortality
Logistics
Creatinine
Azotemia
Gastrointestinal Hemorrhage
Hospital Records
Bacteremia
Hospital Mortality
Logistic Models
Regression Analysis
Hemorrhage

Keywords

  • Creatinine
  • Hepatorenal syndrome
  • Liver
  • MELD
  • Outcome
  • Renal dysfunction

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Acute kidney injury and chronic kidney disease in hospitalized patients with cirrhosis. / Warner, Nafisseh Sirjani; Cuthbert, Jennifer A.; Bhore, Rafia; Rockey, Don C.

In: Journal of Investigative Medicine, Vol. 59, No. 8, 12.2011, p. 1244-1251.

Research output: Contribution to journalArticle

Warner, Nafisseh Sirjani ; Cuthbert, Jennifer A. ; Bhore, Rafia ; Rockey, Don C. / Acute kidney injury and chronic kidney disease in hospitalized patients with cirrhosis. In: Journal of Investigative Medicine. 2011 ; Vol. 59, No. 8. pp. 1244-1251.
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