title: Acute kidney injury and chronic kidney disease in hospitalized patients with cirrhosis.
abstract: BACKGROUND
  Renal dysfunction is a common and potentially life-threatening complication in hospitalized patients with cirrhosis.
  
  
  OBJECTIVE
  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 and multivariable 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.
authors.affiliation: Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center and Parkland Memorial Hospital, Dallas, TX, USA.
authors.forename: Nafisseh Sirjani
authors.initials: NS
authors.lastname: Warner
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Cuthbert
authors.forename: Rafia
authors.initials: R
authors.lastname: Bhore
authors.forename: Don C
authors.initials: DC
authors.lastname: Rockey
mesh_terms: D058186:Acute Kidney Injury / Q000145:classification / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000145:classification / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013781:Texas / Q000453:epidemiology