Changing epidemiology and outcomes of acute kidney injury in hospitalized patients with cirrhosis – a US population-based study

Desai, Archita P.; Knapp, Shannon M.; Orman, Eric S.; Ghabril, Marwan; Nephew, Lauren; Anderson, Mary R.; Ginès, Pere; Chalasani, Naga; Patidar, Kavish R.

doi:10.1016/j.jhep.2020.04.043

Cited by 53 publications

(58 citation statements)

References 44 publications

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“…In turn, the presence of AKI in cirrhosis resulted in an increase of $5,048 in median admission cost. ( 32 ) In a cohort study of 39,719 patients who underwent liver transplant, those with CKD pre‐liver transplantation had a 16% higher mortality risk after the liver transplant relative to patients without CKD pre‐liver transplantation. ( 33 ) A study of over 1 million CLD‐related hospitalizations found the cost of inpatient admission in 2016 to be 18.6% higher in patients with CLD with CKD compared to CLD alone.…”

Section: Discussionmentioning

confidence: 99%

Health Care Resource Use and Cost Burden of Chronic Kidney Disease in Patients With Chronic Liver Disease: A Real‐World Claims Analysis

Rustgi

John

et al. 2020

Hepatol. Commun.

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Chronic Liver Disease (CLD) is associated with an increased risk of chronic kidney disease (CKD). However, the health care burden of CKD in the CLD spectrum is unknown. We aimed to evaluate the health care use and cost burdens associated with CKD in patients with CLD in the United States by using real-world claims data. We analyzed data from the Truven Health MarketScan Commercial Claims database from 2010 to 2015. A total of 19,664 patients with CLD with or without comorbid CKD were identified using International Classification of Diseases, Ninth Revision, codes and matched 1:1 by sociodemographic characteristics and comorbidities using propensity scores. Total and service-specific unadjusted and adjusted health care parameters were analyzed for the 12 months following an index date selected at random to capture whole disease burdens. In CLD, comorbid CKD was associated with a higher annual number of claims per person (CKD vs. no CKD, 69 vs. 55) and higher total annual median health care costs (CKD vs. no CKD, $21,397 vs. $16,995). A subanalysis stratified by CKD category showed that health care use and cost burden in CLD increased with disease stage, with a peak 12-month median cost difference of $77,859 in patients on dialysis. The adjusted per person annual health care cost was higher for CKD cases compared to controls ($35,793 vs. $24,048, respectively; P < 0.0001). Stratified by the type of CLD, the highest between-group adjusted cost differences were for cirrhosis, viral hepatitis, hemochromatosis, and nonalcoholic fatty liver disease. Conclusion: CKD is a cost multiplier in CLD. The CKD health care burden in liver disease differs by the type of CLD. Improved CKD screening and proactive treatment interventions for at-risk patients can limit the excess burden associated with CKD in patients with CLD. (Hepatology Communications 2020;4:1404-1418).

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Section: Discussionmentioning

confidence: 99%

Health Care Resource Use and Cost Burden of Chronic Kidney Disease in Patients With Chronic Liver Disease: A Real‐World Claims Analysis

Rustgi

John

et al. 2020

Hepatol. Commun.

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“…Renal dysfunction is one of common complications of liver cirrhosis, especially in patients with ascites [22]. Desai et al reported that the prevalence of AKI in hospitalized cirrhotic patients had significantly increased in US [23]. This study showed that the presence of ascites was an independent risk factor for AKI in patients with HCC underwent TACE.…”

Section: Discussionmentioning

confidence: 63%

Effect of acute kidney injury on the patients with hepatocellular carcinoma undergoing transarterial chemoembolization

et al. 2020

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The purpose of this study was to investigate the effect of acute kidney injury (AKI) on the prognosis of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). A total of 347 HCC patients with Child-Pugh class A and pre-TACE serum creatinine (SCr) ≤1.5 mg/dL undergoing TACE as an initial therapy 2000–2014 were analyzed. Overall survival with related risk factors including AKI was investigated. We assessed AKI based on the International Club of Ascites (ICA)-AKI criteria. The mean age was 60.9 years. Of 347 patients, death was observed in 109 patients (31.4%). The mean SCr levels at pre-TACE, one day, two months, and four months after TACE were 0.9, 0.9, 0.9, and 1.1 mg/dL, respectively. The AKI within four months after TACE developed in 37 patients (11%). The AKI stages were non-AKI in 310 (89%), stage 1 in 10 (3%), stage 2 in 10 (3%), and stage 3 in 17 patients (5%). Multivariable analysis showed that the risk factors for overall survival were serum albumin ≤3.5 g/dL (hazard ratio [HR] 1.58, p = 0.027), BCLC stage B (HR 2.07, p = 0.008), BCLC stage C (HR 3.96, p<0.001), bilobar tumor location (HR 1.66, p = 0.022), AKI stage 1 (HR 6.09, p<0.001), AKI stage 2 (HR 8.51, p<0.001), and AKI stage 3 (HR 17.64, p<0.001). AKI is a crucial prognostic factor for overall survival in HCC patients undergoing TACE. The assessment of AKI based on the ICA-AKI criteria can facilitate evaluation of the prognosis of HCC patients undergoing TACE.

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“…Therefore, our study offers significant insights into the burden and impact of each of the kidney dysfunction types among all patients with cirrhosis. Specifically, we highlight that not just AKI [30], but each of the types of kidney dysfunction (e.g., AKI, CKD, AKI on CKD) is increasing among all patients hospitalized with cirrhosis. We build on these findings by demonstrating that, as compared to those with CKD, those with AKI and AKI on CKD have more than and nearly double the risk of inpatient mortality, respectively.…”

Section: Discussionmentioning

confidence: 99%

Association Between Kidney Dysfunction Types and Mortality Among Hospitalized Patients with Cirrhosis

et al. 2021

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Background and Aims Kidney dysfunction is associated with increased mortality among patients with cirrhosis. We investigated whether kidney dysfunction types [e.g., acute kidney injury (AKI), chronic kidney disease (CKD), and AKI on CKD] were differentially associated with inpatient mortality. Methods We utilized the nationwide inpatient sample, a nationally representative database, from 2007 to 2014. We included all hospitalizations with previously validated codes for cirrhosis or associated decompensated cirrhosis diagnoses. We defined kidney dysfunction types also from previously validated codes, and we grouped hospitalizations into the following diagnoses: normal, AKI, CKD, and AKI on CKD. Our primary outcome was inpatient mortality. Results There were 1,293,779 hospitalizations with cirrhosis sampled in this study. Of these hospitalizations, 849,193 (66%) had normal kidney function, 176,418 (14%) had AKI, 157,600 (12%) had CKD, and 110,568 (9%) had AKI on CKD. We found that the proportion of hospitalizations with AKI, CKD, and AKI on CKD increased significantly throughout the study period (p < 0.001, test for trend for all). Kidney dysfunction type was differentially associated with inpatient mortality, even after adjustment: as compared to those with CKD, normal kidney function: OR 0.75 [95 CI 0.73-0.78], AKI: OR 2.40 [95 CI 2.32-2.48], and AKI on CKD: OR 1.66 ]. Discussion Using a nationally representative cohort of all hospitalizations with cirrhosis, our study highlights that the burden of kidney dysfunction, especially AKI, among hospitalizations with cirrhosis is rising, and the inclusion of kidney dysfunction type may be an opportunity to improve prognostication. KeywordsAcute kidney injury • Chronic kidney disease • Cirrhosis • Hospitalizations • Mortality • National inpatient sample Abbreviations AKI Acute kidney injury CKD Chronic kidney disease MELD Model for end-stage liver disease HCC Hepatocellular carcinoma * Giuseppe Cullaro

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Changing epidemiology and outcomes of acute kidney injury in hospitalized patients with cirrhosis – a US population-based study

Cited by 53 publications

References 44 publications

Health Care Resource Use and Cost Burden of Chronic Kidney Disease in Patients With Chronic Liver Disease: A Real‐World Claims Analysis

Health Care Resource Use and Cost Burden of Chronic Kidney Disease in Patients With Chronic Liver Disease: A Real‐World Claims Analysis

Effect of acute kidney injury on the patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Association Between Kidney Dysfunction Types and Mortality Among Hospitalized Patients with Cirrhosis

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