Liver Int. 2022 Aug 26. doi: 10.1111/liv.15413. Online ahead of print.
ABSTRACT
BACKGROUND AND AIM: There is limited data on natural course and interventions in stage-3 acute kidney injury (AKI-3) in patients with acute-on-chronic liver failure (ACLF). We studied the factors of AKI-3 reversal and outcomes on dialysis in ACLF patients.
METHODS: Consecutive patients with ACLF were prospectively enrolled (n=1022) and variables determining AKI and its outcomes were analyzed.
RESULTS: At one-month, 337(33%) patients had AKI-3, of which, 131 had AKI-3 at enrolment, 206 developed AKI-3 during hospital stay. Of patients with AKI-3 at enrolment, 18% showed terlipressin response, 21% had AKI resolution and 59% required dialysis. High MELD (≥35) (model 1), serum bilirubin (≥ 23 mg/dl) (model 2) and AARC score (≥11) (model 3) were independent risk factors for dialysis. Dialysis was associated with worse survival in all AKI patients but improved outcomes in patients with AKI-3 [p=0.022, HR 0.69(0.50-0.95). Post-mortem kidney biopsies (n= 61) revealed cholemic nephropathy (CN) in 54%, acute tubular necrosis (ATN) in 31%, and a combination (CN and ATN) in 15%. Serum bilirubin was significantly higher in patients with CN, CN and ATN compared with ATN respectively [(30.8 ± 12.2) vs. (26.7 ± 12.0) vs. (18.5 ± 9.8); p=0.002].
CONCLUSION: AKI-3 rapidly increases from 13% to 33% within 30 days in ACLF patients. Histopathological data suggested cholemic nephropathy as the predominant cause which correlated with high bilirubin levels. AKI-3 resolves in only one in five patients. Patients with AARC grade 3 and MELD >35 demand need for early dialysis in AKI-3 for improved outcomes.
PMID:36017749 | DOI:10.1111/liv.15413
