Acute kidney injury in decompensated cirrhosis
- Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
- Correspondence to Dr Florence Wong, 9N/983, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Toronto, ON M5G2C4, Canada;
Contributors CDT and RR contributed to the writing of the research protocol. Both authors recruited the patients and conducted study visits. Both also contributed to the writing of the manuscript. FW conceptualised the idea for the study, and overall supervised the conduct of the study. All three authors approved the final version of the manuscript.
- Revised 17 March 2012
- Accepted 26 April 2012
- Published Online First 25 May 2012
Background Hepatorenal syndrome in cirrhosis with ascites is a well-defined entity with significant morbidity and mortality. It is unclear whether milder degrees of acute kidney injury (AKI), defined as a serum creatinine increase of over 26.4 μmol/l (0.3 mg/dl) or by 50% from baseline, also has a negative impact on patient outcomes.
Objectives To determine the prevalence of AKI in cirrhosis with ascites and the impact of AKI on patient outcomes.
Design Patients with cirrhosis with ascites and baseline serum creatinine less than 110 μmol/l, and no evidence of structural renal disease, prospectively underwent 4–6-weekly blood work-up for full blood count, biochemistry and liver function. Clinical assessments occurred every 4 months for the development of AKI and other complications.
Results 90 patients (mean age 55.8±0.8 years) with a mean follow-up of 14.05±1.07 months were enrolled. 82 episodes of AKI occurred in 49 patients, with the majority of episodes precipitated by a disturbance in systemic haemodynamics. The mean peak serum creatinine of the AKI episodes was within the laboratory's normal range. 73 episodes of AKI resolved; nine did not. There was no clear clinical predictor for the development or resolution of AKI. Despite resolution of most AKI episodes, a gradual and significant increase in serum creatinine and a gradual reduction in mean arterial pressure were observed during follow-up, associated with a significant reduction in survival compared with non-AKI patients.
Conclusion Minor increases in serum creatinine are clinically relevant and can adversely affect survival. Every effort should be made to avoid precipitation of AKI in cirrhosis and ascites.
- Acute kidney injury
- cardiovascular complications
- health service research
- hepatic haemodynamics
- hepatorenal syndrome
- liver cirrhosis
- portal hypertension
- renal dysfunction
Competing interests None.
Patient consent Obtained.
Ethics approval Ethics approval was provided by Research Ethics Committee, University Health Network.
Provenance and peer review Not commissioned; externally peer reviewed.