A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis

Fagundes, Cláudia; Barreto, Rogelio; Guevara, Mónica; García, Elisabet; Solà, Elsa; Rodríguez, Ezequiel; Graupera, Isabel; Ariza, Xavier; Pereira, Gustavo; Alfaro, Ignacio; Cárdenas, Andrés; Fernández, Javier; Poch, Esteban; Ginès, Pere

doi:10.1016/j.jhep.2013.04.036

Cited by 253 publications

(268 citation statements)

References 21 publications

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“…Finally, patients with cirrhosis are at risk of developing both acute and chronic kidney disease [83][84][85][86][87]. In the general population, chronic renal disease is associated with a high thrombotic risk, while in acute renal failure the bleeding risk prevails over that of thrombosis.…”

Section: Factors Tipping the Hemostatic Balance In Cirrhosismentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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a b s t r a c tPatients with cirrhosis present with hemostatic alterations secondary to reduced availability of procoagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014. The statements were graded according to quality of evidence and strength of recommendations, and approved by an independent jury. The statements presented here highlight strengths and weaknesses of current laboratory tests to assess bleeding and thrombotic risk in cirrhotic patients, the pathophysiology of hemostatic perturbations in this condition, and outline the optimal management of bleeding and thrombosis in patients with liver cirrhosis.

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Section: Factors Tipping the Hemostatic Balance In Cirrhosismentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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“…It is interesting to note that there is a relationship between the cause of AKI and mortality in patients with cirrhosis. A study by Fagundes et al demonstrates that AKI secondary to miscellaneous causes has the best survival rate, followed by hypervolemia and infection related-AKI, with AKI related to hepatorenal syndrome having the worst prognosis [98] . The CANONIC study reports that kidney failure is the most common organ failure in ACLF grade 1, indicating the increasing necessity for effective biomarkers in order to detect patients at risk of kidney dysfunction, as well as novel therapeutic strategies to address the poor prognosis of patients with ACLF and co-existing renal impairment.…”

Section: Kidney Dysfunctionmentioning

confidence: 99%

Acute-on-chronic liver failure: recent update

Alam

Suen

2016

J Biomed Res

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Acute on chronic liver failure (ACLF) was first described in 1995 as a clinical syndrome distinct to classic acute decompensation. Characterized by complications of decompensation, ACLF occurs on a background of chronic liver dysfunction and is associated with high rates of organ failure and significant short-term mortality estimated between 45% and 90%. Despite the clinical relevance of the condition, it still remains largely undefined with continued disagreement regarding its precise etiological factors, clinical course, prognostic criteria and management pathways. It is concerning that, despite our relative lack of understanding of the condition, the burden of ACLF among cirrhotic patients remains significant with an estimated prevalence of 30.9%. This paper highlights our current understanding of ACLF, including its etiology, diagnostic and prognostic criteria and pathophysiology. It is evident that further refinement of the ACLF classification system is required in order to detect high-risk patients and improve short-term mortality rates. The field of metabolomics certainly warrants investigation to enhance diagnostic and prognostic parameters, while the use of granulocyte-colony stimulating factor is a promising future therapeutic intervention for patients with ACLF.

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“…Increased SCr × 1.5 to 1.9 the basal value or ≥ 0.3 mg/dL or urine output < 0.5 mL/kg per hour for 6-12 h Stage 2 (injury) Increased SCr × 2 the basal value or GFR decrease > 50% or urine output < 0.5 mL/ kg per hour for 12 h Increased SCr × 2 to 3 the basal value or urine output < 0.5 mL/kg per hour for > 12 h Increased SCr × 2 to 2.9 the basal value or urine output < 0.5 mL/kg per hour for ≥ 12 h Rognant N. Acute kidney injury in patients with liver disease Portal hypertension AKI rate [22] . A study by Piano et al [23] compared the use of "conventional" criteria of AKI diagnosis (i.e., incease of SCr by 50% to a level above 1.5 mg/dL) to the new AKIN criteria in predicting hospital mortality in cirrhotic patients.…”

Section: Definition Of Akimentioning

confidence: 99%

“…Moreover, whether less severe AKI could impact renal prognosis in these patients has to be established as well. Finally, the true impact on the patients' prognosis of the cause of AKI should be assessed to avoid its potential confounding role, as suggested by Fagundes et al [22] and also by a study in liver transplant recipients by Nadim et al [24] (in which the cause of AKI was the single factor with independent impact on oneyear posttransplantation mortality rate).…”

Section: Definition Of Akimentioning

confidence: 99%

“…The results of two other studies suggested that a change in the AKIN classification could help to refine the prognosis of cirrhotic patients. Fagundes et al [22] tested the clinical effectiveness of the AKIN classification in hospitalised cirrhotic patients and found a higher 90d mortality rate in patients with AKI compared to nonAKI patients (most of them presenting stage 1 AKI). However, their results showed that mortality rate was lower in stage 1 patients when it was compared to those with stage 2 or 3 AKI (whereas no difference was seen between patients with stage 2 and those with stage 3).…”

Section: Studies That Tested the Rifle/ Akin Classification In Cirrhomentioning

confidence: 99%

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Acute kidney injury in patients with chronic liver disease

Rognant¹

2015

WJH

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Acute kidney injury (AKI) is a frequent clinical event in patients with liver disease, compounding their prognosis. Furthermore, it is likely that the occurrence of AKI has a detrimental impact on the subsequent renal function and the long-term survival of these patients. Recently, some authors advocated the use of new diagnostic criteria for detecting acute kidney injury in patients with cirrhosis. These criteria are based on the rapidity and extent of the creatinine increase comparing to the basal creatinine and also on the kinetics of diuresis decrease. Although their validity in this population requires further studies to be clearly established, these new criteria could have two advantages: (1) to allow earlier diagnosis of AKI and, thus, hepatorenal syndrome for which earlier intervention could improve patients' survival; and (2) to promote more intensive monitoring of renal function in these patients with high risk of AKI. Finally, recent practice guidelines about the prevention and treatment of general AKI have been published which should be useful in optimising the management of AKI in cirrhotic patients.

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A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis

Cited by 253 publications

References 21 publications

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Acute-on-chronic liver failure: recent update

Acute kidney injury in patients with chronic liver disease

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