AKI in patients with acute on chronic liver failure is different from acute decompensation of cirrhosis.
OBJECTIVE
The current definitions of acute kidney injury (AKI) including HRS have been derived from patients with decompensated cirrhosis. No studies have carefully addressed AKI in patients with acute on chronic liver failure (ACLF). We evaluated the prevalence, spectrum, natural history and mortality of AKI at admission and new-onset AKI in hospitalized patients with ACLF and compared the results with patients with acute decompensation of cirrhosis (ADC).


METHODS
Consecutive patients with ACLF (n = 382) and ADC (n = 451) were prospectively studied. Serial renal and liver functions were recorded and correlated with the disease course and outcome.


RESULTS
AKI at admission and new onset AKI in the hospital were not different in patients with ACLF and ADC (p > 0.05). However, a significant difference in the spectrum of AKI was noted; functional volume-responsive AKI was more common (p < 0.05) in ADC, while patients with ACLF more frequently had the structural form of AKI (p < 0.05). Moreover, patients with ADC had significantly less AKI progression (p < 0.05) and prolonged duration (p < 0.05), a lower requirement of RRT (p < 0.05) and also less AKI resolution (p < 0.05) compared to ACLF patients. Patients with ACLF (versus ADC) had a significantly higher mortality on multivariate analysis.


CONCLUSIONS
The kidneys are differentially affected in patients with cirrhosis with or without liver failure. Patients with ACLF with AKI have more structural AKI, greater potential for reversibility despite higher progression as well as higher mortality compared to patients with ADC. Prevention and early detection of AKI should be considered in patients with ACLF.
Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.
Rakhi
R
Maiwall
Department of Clinical Hematology, Command Hospital (Eastern Command), Kolkata, India.
Suman
S
Kumar
Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.
Shivendra Singh
SS
Chandel
Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.
Guresh
G
Kumar
Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.
Archana
A
Rastogi
Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.
Chhagan
C
Bihari
Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.
Manoj Kumar
MK
Sharma
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
Bhaskar
B
Thakur
Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.
K
K
Jamwal
Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India.
Suman
S
Nayak
Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India.
R P
RP
Mathur
Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India. shivsarin@gmail.com.
S K
SK
Sarin
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D065290:Acute-On-Chronic Liver Failure / Q000150:complications* / Q000175:diagnosis; D000328:Adult; D001706:Biopsy; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007668:Kidney / Q000473:pathology; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
ACLF; AKI; CLD; Hepatorenal syndrome; Progression of AKI; Renal failure