title: A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis.
abstract: OBJECTIVE
  The Acute Kidney Injury Network (AKIN) criteria are widely used in nephrology, but information on cirrhosis is limited. We aimed at evaluating the AKIN criteria and their relationship with the cause of kidney impairment and survival.
  
  
  METHODS
  We performed a prospective study of 375 consecutive patients hospitalized for complications of cirrhosis. One-hundred and seventy-seven (47%) patients fulfilled the criteria of Acute Kidney Injury (AKI) during hospitalization, the causes being hypovolemia, infections, hepatorenal syndrome (HRS), nephrotoxicity, and miscellaneous (62, 54, 32, 8, and 21 cases, respectively).
  
  
  RESULTS
  At diagnosis, most patients had AKI stage 1 (77%). Both the occurrence of AKI and its stage were associated with 3-month survival. However, survival difference between stages 2 and 3 was not statistically significant. Moreover, if stage 1 patients were categorized into 2 groups according to the level of serum creatinine used in the classical definition of kidney impairment (1.5mg/dl), the two groups had a significantly different outcome. Combining AKIN criteria and maximum serum creatinine, 3 risk groups were identified: (A) patients with AKI stage 1 with peak creatinine ≤ 1.5mg/dl; (B) patients with stage 1 with peak creatinine >1.5mg/dl; and (C) patients with stages 2-3 (survival 84%, 68%, and 36%, respectively; p<0.001). Survival was independently related to the cause of kidney impairment, patients with HRS or infection-related having the worst prognosis.
  
  
  CONCLUSIONS
  A classification that combines the AKIN criteria and classical criteria of kidney failure in cirrhosis provides a better risk stratification than AKIN criteria alone. The cause of impairment in kidney function is key in assessing prognosis in cirrhosis.
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain.
authors.forename: Claudia
authors.initials: C
authors.lastname: Fagundes
authors.forename: Rogelio
authors.initials: R
authors.lastname: Barreto
authors.forename: Mónica
authors.initials: M
authors.lastname: Guevara
authors.forename: Elisabet
authors.initials: E
authors.lastname: Garcia
authors.forename: Elsa
authors.initials: E
authors.lastname: Solà
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Rodríguez
authors.forename: Isabel
authors.initials: I
authors.lastname: Graupera
authors.forename: Xavier
authors.initials: X
authors.lastname: Ariza
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pereira
authors.forename: Ignacio
authors.initials: I
authors.lastname: Alfaro
authors.forename: Andrés
authors.initials: A
authors.lastname: Cárdenas
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández
authors.forename: Esteban
authors.initials: E
authors.lastname: Poch
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: D058186:Acute Kidney Injury / Q000145:classification* / Q000209:etiology* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D005260:Female; D006530:Hepatorenal Syndrome / Q000150:complications / Q000503:physiopathology; D006801:Humans; D007239:Infections / Q000150:complications / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D003404:Creatinine
keywords: AKI; AKIN; Acute Kidney Injury; Acute Kidney Injury Network; Acute kidney injury; Ascites; C-reactive protein; CRP; Cirrhosis; GFR; HRS; Hepatorenal syndrome; ICU; Kidney failure; MELD; Model for End-Stage Liver Disease; SIRS; glomerular filtration rate; hepatorenal syndrome; intensive care unit; systemic inflammatory response syndrome