Impact of Acute Kidney Injury on Mortality of Patients Hospitalized for Complications of Cirrhosis

Nuthalapati, Anantha K.; Schluterman, Nicholas; Khanna, Anuj; Greenberg, David H.; Thuluvath, Paul J.

doi:10.1016/j.jceh.2017.05.004

Cited by 7 publications

(4 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…48 With each episode of AKI, the renal reserve declines due to the inability of kidneys to recover function completely to original baseline level and resulting in risk for development of chronic kidney disease and impacting the outcomes negatively. 31,33 While patients with cirrhosis constitute a heterogeneous cohort, the subpopulations at an increased risk of developing AKI have not been sufficiently studied. In our pooled analysis, model for end-stage liver disease score, Child-Pugh stage, presence of ascites, and presence of severe sepsis/septic shock were associated with an elevated risk of developing an AKI.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence, Mortality and Predictors of Acute Kidney Injury in Patients with Cirrhosis: A Systematic Review and Meta-analysis

Tariq¹,

Hadi²,

Chahal³

et al. 2020

Journal of Clinical and Translational Hepatology

View full text Add to dashboard Cite

Background and Aims: Acute kidney injury (AKI) is common in patients with cirrhosis but the incidence is heterogeneous among studies. We performed a meta-analysis to describe the incidence of AKI and its impact on patient mortality in patients with cirrhosis. We also evaluated the admission variables predicting development of AKI. Methods: A systematic search of various databases was performed up to November 2018. Meta-analyses were performed using random effects models. Results: Of 18,474 patients with cirrhosis from 30 selected studies, 5,648 developed AKI, with a pooled incidence of 29% (95% confidence interval [CI]: 28-30%, I 2 of 99%). In-hospital mortality assessed in eight studies was six-fold higher among AKI patients, as compared to those without AKI (odds ratio [OR] 6.72, 95% CI: 3.47-13, p<0.0001, I 2 of 70%). Three studies on patients admitted to intensive care showed about six-fold higher mortality among AKI patients (OR 5.90, 95% CI: 3.21-10.85, p>0.0001). Mortality remained significantly high, at days 30 and 90 and even at 1-year follow up after development of AKI. Of 12 admission variables analyzed, model for end-stage liver disease score, Child-Pugh-Turcotte stage C, presence of ascites, and presence of sepsis/septic shock were statistically significant risk factors for AKI. Conclusions: AKI occurred in about 29% of patients with cirrhosis and is associated with a six-fold increased risk of in-hospital mortality. Mortality remained high even in long-term follow-up of 1 year. Patients at risk for AKI development can be recognized at admission. Prospective studies are needed to develop strategies for improving outcome of these patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence, Mortality and Predictors of Acute Kidney Injury in Patients with Cirrhosis: A Systematic Review and Meta-analysis

Tariq¹,

Hadi²,

Chahal³

et al. 2020

Journal of Clinical and Translational Hepatology

View full text Add to dashboard Cite

show abstract

“…AKI in LC patients, especially those who are not candidates for liver transplantation, is extremely challenging to treat. Several previous studies demonstrated that development of AKI was an independent prognostic factor for mortality in LC patients [ 12 , 22 – 25 ]. In the current study, we investigated the clinical characteristics of LC patients initiating CRRT and explored factors associated with in-hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and prognostic factors of mortality in liver cirrhosis patients on continuous renal replacement therapy in two tertiary hospitals in Korea

Jeon

Kim

Jang

et al. 2021

Kidney Res Clin Pract

View full text Add to dashboard Cite

Background Data on liver cirrhosis (LC) patients undergoing continuous renal replacement therapy (CRRT) are lacking despite of the dismal prognosis. We therefore evaluated clinical characteristics and predictive factors related to mortality in LC patients undergoing CRRT. Methods We performed a retrospective observational study at two tertiary hospitals in Korea. A total of 229 LC patients who underwent CRRT were analyzed. Patients were classified into survivor and non-survivor groups. We used multivariable Cox regression analyses to identify predictive factors of in-hospital mortality. Results During a median follow-up of 5 days (interquartile range, 1–19 days), in-hospital mortality rate was 66.4%. In multivariable analysis, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.01–1.06; p = 0.02), Model for End-Stage Liver Disease (MELD) score (HR, 1.08; 95% CI, 1.04–1.11; p < 0.001), and delivered CRRT dose (HR, 0.95; 95% CI, 0.92–0.98; p = 0.002) were significant risk factors for in-hospital mortality. Patients with a CRRT delivered dose < 25 mL/kg/hr had a higher mortality rate than those with a delivered dose > 35 mL/kg/hr (HR, 3.13; 95% CI, 1.62–6.05; p = 0.001). Subgroup analysis revealed that a CRRT delivered dose < 25 mL/kg/hr was a significant risk factor for in-hospital mortality among LC patients with a MELD score ≥ 30. Conclusion High APACHE II score, high MELD score, and low delivered CRRT dose were significant risk factors for in-hospital mortality. CRRT delivered dose impacted mortality significantly, especially in patients with a MELD score ≥ 30.

show abstract

“…AKI involves the sudden onset of kidney damage or failure within a short period of time and can be characterized by decreased blood flow to the kidneys, kidney tubular damage and inflammation, vasculitis, and the possibility of sepsis and death, all effects that can be caused or worsened by COVID-19. − The presence of AKI consistently worsens outcomes for patients with a variety of other conditions, including myocardial infarction and heart disease, cirrhosis, and viral diseases like COVID-19. − Furthermore, among patients with concurrent AKI and COVID-19 infection, compared to early stage AKI, late-stage AKI was more closely associated with higher levels of inflammatory markers and increased mortality …”

Section: Introductionmentioning

confidence: 99%

Blending of Designer Synthetic Polymers to a Dual Targeted Nanoformulation for SARS-CoV-2 Associated Kidney Damage

et al. 2021

View full text Add to dashboard Cite

As the COVID-19 pandemic has continued to spread, studies have shown that hospitalized COVID-19 patients are at significant risk for developing acute kidney injury (AKI), which can cause increased morbidity, the need for dialysis treatment, chronic kidney diseases, and even death. In this paper, we present a proof-of-concept study for the utilization of combination therapeutic-loaded dual-targeted biodegradable nanoparticles (NPs) to treat concurrent AKI and COVID-19 in patients by delivering the therapeutics across the gut epithelial barrier and to the kidney, in order to lower the viral load as well as reduce the symptoms of AKI. Despite recent vaccination efforts and the end of the COVID-19 pandemic in sight, problems related to the long-term effects of COVID-19 will continue to persist, including impacts on patients suffering from AKI and other chronic renal conditions. Therefore, the dual-targeted blended polymeric NP developed in this study to treat concurrent COVID-19 infection and AKI is a useful proof-of-concept nanoplatform for future treatments of these complications.

show abstract

Impact of Acute Kidney Injury on Mortality of Patients Hospitalized for Complications of Cirrhosis

Abstract: In patients with cirrhosis, any increment in serum creatinine within 48 h from hospitalization is associated with a higher mortality provided the peak serum creatinine within 48 h is above 1.2 mg/dL.

Cited by 7 publications

References 48 publications

Incidence, Mortality and Predictors of Acute Kidney Injury in Patients with Cirrhosis: A Systematic Review and Meta-analysis

Incidence, Mortality and Predictors of Acute Kidney Injury in Patients with Cirrhosis: A Systematic Review and Meta-analysis

Clinical outcomes and prognostic factors of mortality in liver cirrhosis patients on continuous renal replacement therapy in two tertiary hospitals in Korea

Blending of Designer Synthetic Polymers to a Dual Targeted Nanoformulation for SARS-CoV-2 Associated Kidney Damage

Contact Info

Product

Resources

About