Prognosis of Patients with Cirrhosis and AKI Who Initiate RRT

• Published in: Clinical journal of the American Society of Nephrology Vol. 13; no. 1; pp. 16 - 25
• Main Authors: Allegretti, Andrew S., Parada, Xavier Vela, Eneanya, Nwamaka D., Gilligan, Hannah, Xu, Dihua, Zhao, Sophia, Dienstag, Jules L., Chung, Raymond T., Thadhani, Ravi I.
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 06.01.2018
• Subjects: Acute Kidney Injury - diagnosis; Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Comorbidity; Female; Health Status; Hepatorenal Syndrome - diagnosis; Hepatorenal Syndrome - mortality; Hepatorenal Syndrome - therapy; Humans; Liver Cirrhosis - diagnosis; Liver Cirrhosis - mortality; Liver Cirrhosis - therapy; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Male; Massachusetts - epidemiology; Middle Aged; Original; Renal Dialysis - adverse effects; Renal Dialysis - mortality; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Waiting Lists; Massachusetts; dialysis; renal replacement therapy; Prognosis; continuous renal replacement therapy; Humans; Proportional Hazards Models; acute tubular necrosis; Liver Cirrhosis; Survival Analysis; hepatorenal syndrome; hemodialysis; Retrospective Studies; acute kidney injury; futility; Kidney Tubular Necrosis, Acute; cirrhosis; liver transplantation; renal dialysis; transplant-free survival
• ISSN: 1555-9041; 1555-905X; 1555-905X
• DOI: 10.2215/CJN.03610417

Literature on the prognosis of patients with cirrhosis who require RRT for AKI is sparse and is confounded by liver transplant eligibility. An update on outcomes in the nonlisted subgroup is needed. Our objective was to compare outcomes in this group between those diagnosed with hepatorenal syndrome and acute tubular necrosis, stratifying by liver transplant listing status. Retrospective cohort study of patients with cirrhosis acutely initiated on hemodialysis or continuous RRT at five hospitals, including one liver transplant center. Multivariable regression and survival analysis were performed. Four hundred seventy-two subjects were analyzed (341 not listed and 131 listed for liver transplant). Among nonlisted subjects, 15% (51 of 341) were alive at 6 months after initiating RRT. Median survival was 21 (interquartile range [IQR], 8, 70) days for those diagnosed with hepatorenal syndrome and 12 (IQR, 3, 43) days for those diagnosed with acute tubular necrosis ( =0.25). Among listed subjects, 48% (63 of 131) received a liver transplant. Median transplant-free survival was 15 (IQR, 5, 37) days for those diagnosed with hepatorenal syndrome and 14 (IQR, 4, 31) days for those diagnosed with acute tubular necrosis ( =0.60). When stratified by transplant listing, with adjusted Cox models we did not detect a difference in the risk of death between hepatorenal syndrome and acute tubular necrosis (hazard ratio [HR], 0.81; 95% confidence interval [95% CI], 0.59 to 1.11, among those not listed; HR, 0.73; 95% CI, 0.44 to 1.19, among those listed). Cause of AKI was not significantly associated with mortality in patients with cirrhosis who required RRT. Among those not listed for liver transplant, mortality rates were extremely high in patients both with hepatorenal syndrome and acute tubular necrosis. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_11_09_CJASNPodcast_18_1_A.mp3.