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AKI in patients with acute on chronic liver failure is different from acute decompensation of cirrhosis.
Hepatol Int 2015; 9(4):627-39HI

Abstract

BACKGROUND AND AIMS

The current definitions of acute kidney injury (AKI) including HRS have been derived from patients with decompensated cirrhosis. No studies have carefully addressed AKI in patients with acute on chronic liver failure (ACLF). We evaluated the prevalence, spectrum, natural history and mortality of AKI at admission and new-onset AKI in hospitalized patients with ACLF and compared the results with patients with acute decompensation of cirrhosis (ADC).

PATIENTS AND METHODS

Consecutive patients with ACLF (n = 382) and ADC (n = 451) were prospectively studied. Serial renal and liver functions were recorded and correlated with the disease course and outcome.

RESULTS

AKI at admission and new onset AKI in the hospital were not different in patients with ACLF and ADC (p > 0.05). However, a significant difference in the spectrum of AKI was noted; functional volume-responsive AKI was more common (p < 0.05) in ADC, while patients with ACLF more frequently had the structural form of AKI (p < 0.05). Moreover, patients with ADC had significantly less AKI progression (p < 0.05) and prolonged duration (p < 0.05), a lower requirement of RRT (p < 0.05) and also less AKI resolution (p < 0.05) compared to ACLF patients. Patients with ACLF (versus ADC) had a significantly higher mortality on multivariate analysis.

CONCLUSIONS

The kidneys are differentially affected in patients with cirrhosis with or without liver failure. Patients with ACLF with AKI have more structural AKI, greater potential for reversibility despite higher progression as well as higher mortality compared to patients with ADC. Prevention and early detection of AKI should be considered in patients with ACLF.

Authors+Show Affiliations

Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.Department of Clinical Hematology, Command Hospital (Eastern Command), Kolkata, India.Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India. shivsarin@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26329121

Citation

Maiwall, Rakhi, et al. "AKI in Patients With Acute On Chronic Liver Failure Is Different From Acute Decompensation of Cirrhosis." Hepatology International, vol. 9, no. 4, 2015, pp. 627-39.
Maiwall R, Kumar S, Chandel SS, et al. AKI in patients with acute on chronic liver failure is different from acute decompensation of cirrhosis. Hepatol Int. 2015;9(4):627-39.
Maiwall, R., Kumar, S., Chandel, S. S., Kumar, G., Rastogi, A., Bihari, C., ... Sarin, S. K. (2015). AKI in patients with acute on chronic liver failure is different from acute decompensation of cirrhosis. Hepatology International, 9(4), pp. 627-39. doi:10.1007/s12072-015-9653-x.
Maiwall R, et al. AKI in Patients With Acute On Chronic Liver Failure Is Different From Acute Decompensation of Cirrhosis. Hepatol Int. 2015;9(4):627-39. PubMed PMID: 26329121.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - AKI in patients with acute on chronic liver failure is different from acute decompensation of cirrhosis. AU - Maiwall,Rakhi, AU - Kumar,Suman, AU - Chandel,Shivendra Singh, AU - Kumar,Guresh, AU - Rastogi,Archana, AU - Bihari,Chhagan, AU - Sharma,Manoj Kumar, AU - Thakur,Bhaskar, AU - Jamwal,K, AU - Nayak,Suman, AU - Mathur,R P, AU - Sarin,S K, Y1 - 2015/09/02/ PY - 2015/03/27/received PY - 2015/07/13/accepted PY - 2015/9/3/entrez PY - 2015/9/4/pubmed PY - 2016/8/5/medline KW - ACLF KW - AKI KW - CLD KW - Hepatorenal syndrome KW - Progression of AKI KW - Renal failure SP - 627 EP - 39 JF - Hepatology international JO - Hepatol Int VL - 9 IS - 4 N2 - BACKGROUND AND AIMS: The current definitions of acute kidney injury (AKI) including HRS have been derived from patients with decompensated cirrhosis. No studies have carefully addressed AKI in patients with acute on chronic liver failure (ACLF). We evaluated the prevalence, spectrum, natural history and mortality of AKI at admission and new-onset AKI in hospitalized patients with ACLF and compared the results with patients with acute decompensation of cirrhosis (ADC). PATIENTS AND METHODS: Consecutive patients with ACLF (n = 382) and ADC (n = 451) were prospectively studied. Serial renal and liver functions were recorded and correlated with the disease course and outcome. RESULTS: AKI at admission and new onset AKI in the hospital were not different in patients with ACLF and ADC (p > 0.05). However, a significant difference in the spectrum of AKI was noted; functional volume-responsive AKI was more common (p < 0.05) in ADC, while patients with ACLF more frequently had the structural form of AKI (p < 0.05). Moreover, patients with ADC had significantly less AKI progression (p < 0.05) and prolonged duration (p < 0.05), a lower requirement of RRT (p < 0.05) and also less AKI resolution (p < 0.05) compared to ACLF patients. Patients with ACLF (versus ADC) had a significantly higher mortality on multivariate analysis. CONCLUSIONS: The kidneys are differentially affected in patients with cirrhosis with or without liver failure. Patients with ACLF with AKI have more structural AKI, greater potential for reversibility despite higher progression as well as higher mortality compared to patients with ADC. Prevention and early detection of AKI should be considered in patients with ACLF. SN - 1936-0541 UR - https://www.unboundmedicine.com/medline/citation/26329121/AKI_in_patients_with_acute_on_chronic_liver_failure_is_different_from_acute_decompensation_of_cirrhosis_ L2 - https://dx.doi.org/10.1007/s12072-015-9653-x DB - PRIME DP - Unbound Medicine ER -