title: Rifaximin Decreases the Incidence and Severity of Acute Kidney Injury and Hepatorenal Syndrome in Cirrhosis.
abstract: While the effects of rifaximin have been shown to be protective against acute kidney injury (AKI) and hepatorenal syndrome (HRS) in alcohol-induced cirrhosis, its long-term effects on the renal function of other cirrhotic patients are unknown.
  
  
  
  To examine the long-term effects of rifaximin on the renal function of patients with cirrhosis from various etiologies.
  
  
  
  In a retrospective study, we examined cirrhotic patients at the University of Chicago Liver Clinic from January 1, 2011, to December 31, 2014. The study enrolled patients on rifaximin for ≥90 days, who were then matched by age, gender, and MELD score to a control group. Patients with malignancy and renal replacement therapy (RRT) at baseline were excluded. Data were censored at the last follow-up, termination of rifaximin therapy, initiation of RRT, death, or liver transplant.
  
  
  
  Eighty-eight rifaximin cases were identified and matched to 88 control cases. Baseline characteristics were similar, with the exceptions of more prevalent long-term midodrine use (≥90 days) (17.0 vs 4.5 %, p = 0.01) and baseline ascites (37.5 vs 23.8 %, p = 0.05) in the rifaximin group. There was no difference in the frequency of infections, deaths, liver transplants, or hospitalizations. After controlling for cofounders, the incidence rate ratio of AKI (IRR 0.71, p = 0.02) and HRS (IRR 0.21, p = 0.02), as well as the risk of requiring RRT (OR 0.23, p = 0.01), was lower in the rifaximin group.
  
  
  
  Long-term use of rifaximin is associated with a decrease incidence of AKI and HRS and a decrease risk of requiring RRT in a general population of cirrhotic patients.
authors.affiliation: Department of Medicine, UCLA Hospitals, 10945 Le Conte Ave, PVUB 2114 MC694907, Los Angeles, CA, 90095, USA. tsdong@mednet.ucla.edu.
authors.forename: Tien
authors.identifier: 0000-0003-0105-8063
authors.initials: T
authors.lastname: Dong
authors.affiliation: Department of Medicine, Center for Liver Diseases, University of Chicago Medicine, Chicago, IL, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Aronsohn
authors.affiliation: Department of Medicine, Center for Liver Diseases, University of Chicago Medicine, Chicago, IL, USA.
authors.forename: K
authors.initials: K
authors.lastname: Gautham Reddy
authors.affiliation: Department of Medicine, Center for Liver Diseases, University of Chicago Medicine, Chicago, IL, USA.
authors.forename: Helen S
authors.initials: HS
authors.lastname: Te
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D058625:End Stage Liver Disease; D005260:Female; D000069196:Gastrointestinal Microbiome; D006530:Hepatorenal Syndrome / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D012720:Severity of Illness Index; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D012294:Rifamycins; D014662:Vasoconstrictor Agents; D008879:Midodrine; D000078262:Rifaximin
keywords: Cirrhosis; Liver; Microbiome; Portal hypertension