Incidence and risk factors of acute kidney injury in cirrhosis: a systematic review and meta-analysis of 5,202,232 outpatients, inpatients, and ICU-admitted patients

• Published in: Expert review of gastroenterology & hepatology Vol. 18; no. 7; p. 377
• Main Authors: Lekakis, Vasileios, Gkoufa, Aikaterini, Vlachogiannakos, John, Papatheodoridis, George V, Cholongitas, Evangelos
• Format: Journal Article
• Language: English
• Published: England 02.07.2024
• Subjects: Acute Kidney Injury - epidemiology; Hepatic Encephalopathy - epidemiology; Hepatic Encephalopathy - etiology; Hospitalization - statistics & numerical data; Humans; Incidence; Inpatients; Intensive Care Units; Liver Cirrhosis - complications; Liver Cirrhosis - epidemiology; Outpatients; Risk Factors; Cirrhosis; acute on chronic liver failure; infection; hepatic encephalopathy; acute kidney injury; intensive care unit; sepsis
• ISSN: 1747-4132
• DOI: 10.1080/17474124.2024.2380299

Acute kidney injury (AKI) is a commonly seen condition in the natural course of cirrhosis. The aim of this study was to evaluate the pooled incidence and risk factors of AKI in different clinical stages and situations in patients with cirrhosis. Search was conducted on 13 December 2023 across MEDLINE (PubMed), Embase, and Cochrane databases. Meta-analysis was performed using a generalized linear mixed model. In total, 73 studies with 5,202,232 patients were finally enrolled in the meta-analysis. AKI commonly occurs among hospitalized cirrhotics experiencing any decompensation event (29%) as well as among stable outpatients (28%) throughout a 1-year follow-up period. On admission, patients with infection or sepsis/septic shock had the highest AKI rate (47%), followed by those with hepatic encephalopathy (41%). Furthermore, the severity of liver disease proved to be a substantial driver for AKI development, while patients at intensive care unit had the greatest AKI incidence (61%). Both hospitalized patients and stable outpatients with cirrhosis exhibited an elevated susceptibility to AKI. Patients at intensive care unit and those with severe liver disease, infection, sepsis/septic shock, hepatic encephalopathy, or acute on chronic liver failure upon admission are at higher risk for AKI. PROSPERO, registered 09/12/23, CRD42023487736.