TY - JOUR
T1 - Acute kidney injury and chronic kidney disease in hospitalized patients with cirrhosis
AU - Warner, Nafisseh Sirjani
AU - Cuthbert, Jennifer A.
AU - Bhore, Rafia
AU - Rockey, Don C.
PY - 2011/12
Y1 - 2011/12
N2 - 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.
AB - 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.
KW - Creatinine
KW - Hepatorenal syndrome
KW - Liver
KW - MELD
KW - Outcome
KW - Renal dysfunction
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U2 - 10.2310/JIM.0b013e3182321471
DO - 10.2310/JIM.0b013e3182321471
M3 - Article
C2 - 21941210
AN - SCOPUS:84856758917
SN - 1708-8267
VL - 59
SP - 1244
EP - 1251
JO - Journal of Investigative Medicine
JF - Journal of Investigative Medicine
IS - 8
ER -