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Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis
  1. Florence Wong1,
  2. Mitra K Nadim2,
  3. John A Kellum3,
  4. Francesco Salerno4,
  5. Rinaldo Bellomo5,
  6. Alexander Gerbes6,
  7. Paolo Angeli7,
  8. Richard Moreau8,
  9. Andrew Davenport9,
  10. Rajiv Jalan10,
  11. Claudio Ronco11,
  12. Yuri Genyk12,
  13. Vicente Arroyo13
  1. 1Department of Medicine, University of Toronto, Toronto, Canada
  2. 2Division of Nephrology, University of Southern California, Los Angeles, California, USA
  3. 3Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA
  4. 4Policlinico IRCCS San Donato and Dipartimento di Scienze Medico-Chirurgiche, Università di Milano, Milano, Italy
  5. 5Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
  6. 6Liver Center Munich, Klinikum München-Grosshadern, Ludwig-Maximilians-Universität München, München, Germany
  7. 7Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy
  8. 8Centre de Recherche Biomédicale Bichat-Beaujon, Service d'Hépatologie, Hôpital Beaujon, Clichy, France
  9. 9Centre for Nephrology, University College London Medical School, London, UK
  10. 10Institute of Hepatology, University College London Medical School, London, UK
  11. 11Division of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
  12. 12Division of Multiorgan Abdominal Transplantation, University of Southern California, Los Angeles, California, USA
  13. 13Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Spain
  1. Correspondence to Florence Wong, 9N/983, Department of Medicine, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G2C4, Canada; florence.wong{at}


Objectives To propose an improvement on the current classification of renal dysfunction in cirrhosis. Clinicians caring for patients with cirrhosis recognize that the development of renal dysfunction is associated with significant morbidity and mortality. While most cases of renal dysfunction in cirrhosis are functional in nature, developed as a result of changes in haemodynamics, cardiac function, and renal auto-regulation, there is an increasing number of patients with cirrhosis and structural changes in their kidney as a cause of renal dysfunction. Therefore, there is a need for a newer classification to include both functional and structural renal diseases.

Design A working party consisting of specialists from multiple disciplines conducted literature search and developed summary statements, incorporating the renal dysfunction classification used in nephrology. These were discussed and revised to produce this proposal.

Setting Multi-disciplinary international meeting.

Patients None.

Interventions Literature search using keywords of cirrhosis, renal dysfunction, acute kidney injury (AKI), chronic kidney injury (CKD), and hepatorenal syndrome.

Results Acute kidney injury will include all causes of acute deterioration of renal function as indicated by an increase in serum creatinine of >50% from baseline, or a rise in serum creatinine of ≥26.4mol/L (≥0.3mg/dL) in <48hours. Chronic renal disease will be defined as an estimated glomerular filtration rate (GFR) of <60ml/min calculated using the Modification of Diet in Renal Disease 6 (MDRD6) formula, recognising that the MDRD6 formula is not perfect for the cirrhotic patients and this may change as improved means of estimating GFR becomes available. Acute on chronic kidney disease will be defined as AKI superimposed on existing chronic renal disease using the above definitions for AKI and CKD.

Conclusions Accepting this new classification will allow studies into the epidemiology, incidence, prevalence, natural history and the development of new treatments for these subtypes of renal dysfunction in cirrhosis.

  • Acute kidney injury
  • chronic kidney disease
  • cirrhosis
  • creatinine
  • hepatorenal syndrome
  • renal dysfunction
  • liver cirrhosis

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  • Funding The conferences were supported by unrestricted educational grants from Ikaria, Gambro Renal Care, Otsuka Pharmaceutical, Nx-Stage Medical, IV League Inc and Baxter Inc.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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