Recommendations of the Brazilian Society of Hepatology for the Management of Acute Kidney Injury in Patients With Cirrhosis

Terra, Carlos; Mattos, Ângelo Zambam de; Farias, Alberto Queiróz; Kondo, Mário; Filho, José Eymard Moraes de Medeiros; Strauss, Edna; Dutra, Fábio Ricardo Dantas; Mazza, Marcelo; Lopes, Edmundo Pessoa; Pereira, Tiago; Schiavon, Leonardo Lucca; Filho, Roberto José de Carvalho; Fagundes, Cláudia; Bittencourt, Paulo Lisboa

doi:10.1590/s0004-2803.201800000-71

Cited by 7 publications

(10 citation statements)

References 65 publications

(79 reference statements)

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“…Information on diagnostic criteria and management of AKI HRS are outside the scope of this paper and are discussed in detail in the recently published recommendations of the Brazilian Soci ety of Hepatology for the management of acute kidney injury in patients with cirrhosis (27) . This document will focus on the role of invasive procedures for management of AKIHRS and CKDHRS.…”

Section: Part Ii: Hepatorenal Syndromementioning

confidence: 99%

Recommendations for Invasive Procedures in Patients With Diseases of the Liver and Biliary Tract: Report of a Joint Meeting of the Brazilian Society of Hepatology (Sbh), Brazilian Society of Digestive Endoscopy (Sobed) and Brazilian Society of Interventional Radiology and Endovascular Surgery (Sobrice)

Schiavon

Ejima

Menezes

et al. 2019

Arq. Gastroenterol.

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Liver and biliary tract diseases are common causes of morbidity and mortality worldwide. Invasive procedures are usually performed in those patients with hepatobiliary diseases for both diagnostic and therapeutic purposes. Defining proper indications and restraints of commonly used techniques is crucial for proper patient selection, maximizing positive results and limiting complications. In 2018, the Brazilian Society of Hepatology (SBH) in cooperation with the Brazilian Society of Interventional Radiology and Endovascular surgery (SOBRICE) and the Brazilian Society of Digestive Endoscopy (SOBED) sponsored a joint single-topic meeting on invasive procedures in patients with hepatobiliary diseases. This paper summarizes the proceedings of the aforementioned meeting. It is intended to guide clinicians, gastroenterologists, hepatologists, radiologists, and endoscopists for the proper use of invasive procedures for management of patients with hepatobiliary diseases.

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Section: Part Ii: Hepatorenal Syndromementioning

confidence: 99%

Recommendations for Invasive Procedures in Patients With Diseases of the Liver and Biliary Tract: Report of a Joint Meeting of the Brazilian Society of Hepatology (Sbh), Brazilian Society of Digestive Endoscopy (Sobed) and Brazilian Society of Interventional Radiology and Endovascular Surgery (Sobrice)

Schiavon

Ejima

Menezes

et al. 2019

Arq. Gastroenterol.

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“…The most important limiting factor of intermittent therapies is haemodynamic instability. Hypotension during KRT is associated with dialysis technique (volume and ultrafiltration rate, reduction of plasmatic osmolality) and patient characteristics (hypovolemia, vasodilation, liver failure) ( 5 – 8 , 10 , 11 , 29 , 30 ). Hypotension decreases the effectiveness of RRT and aggravates ischemic injury, delaying the recovery of kidney function.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is no previous study that has evaluated the use of PD in ACLF patients with AKI. The same groups also recommend the use of dialysis solutions with bicarbonate for patients with hyperlactatemia and regional anticoagulation (only in the dialysis circuit) for severe coagulopathy ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…Conventional indications include volume overload not responding to diuretics, uremia, metabolic acidosis and refractory hyperkalemia. In patients with HRS, KRT should be indicated in the absence of response or adverse reaction to vasoconstrictors ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

“…Among infections, spontaneous bacterial peritonitis (SBP) and spontaneous bacteremia were the most common. The 90-day mortality was high (60%), but it was particularly high among patients with AKI associated with infections or HRS (2) and among patients that needed kidney replacement therapy (KRT), reaching 80% (2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

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The Role of Peritoneal Dialysis in the Treatment of Acute Kidney Injury in Patients With Acute-on-Chronic Liver Failure: A Prospective Brazilian Study

et al. 2021

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This study aimed to explore the role of peritoneal dialysis (PD) in acute-on-chronic liver disease (ACLD) in relation to metabolic and fluid control and outcome. Fifty-three patients were treated by PD (prescribed Kt/V = 0.40/session), with a flexible catheter, tidal modality, using a cycler and lactate as a buffer. The mean age was 64.8 ± 13.4 years, model of end stage liver disease (MELD) was 31 ± 6, 58.5% were in the intensive care unit, 58.5% needed intravenous inotropic agents including terlipressin, 69.5% were on mechanical ventilation, alcoholic liver disease was the main cause of cirrhosis and the main dialysis indications were uremia and hypervolemia. Blood urea and creatinine levels stabilized after four sessions at around 50 and 2.5 mg/dL, respectively. Negative fluid balance (FB) and ultrafiltration (UF) increased progressively and stabilized around 3.0 L and −2.7 L/day, respectively. Weekly-delivered Kt/V was 2.7 ± 0.37, and 71.7% of patients died. Five factors met the criteria for inclusion in the multivariable analysis. Logistic regression identified as risk factors associated with Acute Kidney Injury (AKI) in ACLD patients: MELD (OR = 1.14, CI 95% = 1.09–2.16, p = 0.001), nephrotoxic AKI (OR = 0.79, CI 95% = 0.61–0.93, p = 0.02), mechanical ventilation (OR = 1.49, CI 95% = 1.14–2.97, p < 0.001), and positive fluid balance (FB) after two PD sessions (OR = 1.08, CI 95% = 1.03–1.91, p = 0.007). These factors were significantly associated with death. In conclusion, our study suggests that careful prescription may contribute to providing adequate treatment for most Acute-on-Chronic Liver Failure (ACLF) patients without contraindications for PD use, allowing adequate metabolic and fluid control, with no increase in the number of infectious or mechanical complications. MELD, mechanical complications and FB were factors associated with mortality, while nephrotoxic AKI was a protective factor. Further studies are needed to better investigate the role of PD in ACLF patients with AKI.

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Vasoconstrictors in hepatorenal syndrome – A critical review

Mattos

Schacher

Mattos

2019

Annals of Hepatology

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Recommendations of the Brazilian Society of Hepatology for the Management of Acute Kidney Injury in Patients With Cirrhosis

Cited by 7 publications

References 65 publications

The Role of Peritoneal Dialysis in the Treatment of Acute Kidney Injury in Patients With Acute-on-Chronic Liver Failure: A Prospective Brazilian Study

Vasoconstrictors in hepatorenal syndrome – A critical review

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