• Acute kidney injury
• Decompensated cirrhosis
• Nomogram
• Predictive model
• Risk factors

In patients with cirrhosis and AKI requiring renal replacement therapy (RRT), hepatorenal syndrome-AKI was not associated with an increased 90-day mortality when compared with other AKI etiologies. Etiology of AKI may not be a critical factor regarding decisions to trial RRT in acutely ill patients with cirrhosis and AKI. Although elevated, mortality rates in this study are comparable with those reported in general hospitalized patients with AKI requiring RRT.

While AKI requiring renal replacement therapy (AKI-RRT) is associated with increased mortality in heterogeneous inpatient populations, the epidemiology of AKI-RRT in hospitalized patients with cirrhosis is not fully known. Herein, we evaluated the association of etiology of AKI with mortality in hospitalized patients with cirrhosis and AKI-RRT in a multicentric contemporary cohort.

This is a multicenter retrospective cohort study using data from the HRS-HARMONY consortium, which included 11 US hospital network systems. Consecutive adult patients admitted in 2019 with cirrhosis and AKI-RRT were included. The primary outcome was 90-day mortality, and the main independent variable was AKI etiology, classified as hepatorenal syndrome (HRS-AKI) versus other (non–HRS-AKI). AKI etiology was determined by at least two independent adjudicators. We performed Fine and Gray subdistribution hazard analyses adjusting for relevant clinical variables.

Of 2063 hospitalized patients with cirrhosis and AKI, 374 (18.1%) had AKI-RRT. Among them, 65 (17.4%) had HRS-AKI and 309 (82.6%) had non–HRS-AKI, which included acute tubular necrosis in most cases (62.6%). Continuous renal replacement therapy was used as the initial modality in 264 (71%) of patients, while intermittent hemodialysis was used in 108 (29%). The HRS-AKI (versus non–HRS-AKI) group received more vasoconstrictors for HRS management (81.5% versus 67.9%), whereas the non–HRS-AKI group received more mechanical ventilation (64.3% versus 50.8%) and more continuous renal replacement therapy (versus intermittent hemodialysis) as the initial RRT modality (73.9% versus 56.9%). In the adjusted model, HRS-AKI (versus non–HRS-AKI) was not independently associated with increased 90-day mortality (subdistribution hazard ratio, 1.36; 95% confidence interval, 0.95 to 1.94).

In this multicenter contemporary cohort of hospitalized adult patients with cirrhosis and AKI-RRT, HRS-AKI was not independently associated with an increased risk of 90-day mortality when compared with other AKI etiologies. The etiology of AKI appears less relevant than previously considered when evaluating the prognosis of hospitalized adult patients with cirrhosis and AKI requiring RRT.

• acute kidney failure
• aki
• dialysis
• hemodialysis
• hospitalization
• liver failure
• mortality
• outcomes
• renal dialysis

• R01 DK128208 NIDDK NIH HHS
• R01 DK133539 NIDDK NIH HHS
• U54 DK137307 NIDDK NIH HHS

• acute kidney injury
• cirrhosis
• hepatorenal syndrome
• liver disease
• terlipressin

• Humans
• Liver Cirrhosis/complications
• Intensive Care Units
• Critical Care
• Hospitalization
• Hospital Mortality
• Prognosis

To compare the risk of mortality in patients with cirrhosis with and without the associated acute kidney injury (AKI).

We performed a systematic search in the PubMed, Embase, and Scopus databases for observational studies that were done on patients with cirrhosis. Eligible studies reported AKI in patients with cirrhosis and compared mortality among patients with and without AKI. We used a random-effects model, using STATA version 16.0, for deriving pooled effect sizes that were reported as odds ratio (OR) with 95% confidence intervals (CIs).

Thirty-two studies were included. In patients with cirrhosis, AKI was significantly associated with higher in-hospital mortality (OR 5.92), and mortality at 30 days (OR 4.78), 90 days (OR 4.34), and at 1 year follow-up (OR 4.82) compared to patients without AKI.

AKI is associated with an increased risk of mortality in patients with cirrhosis. Careful monitoring to identify the development of AKI and early prompt management is necessary.

• Combined liver-kidney transplantation
• HRS pathophysiology
• Hepatorenal syndrome
• Nitric oxide
• Splanchnic vasodilatation

• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/etiology
• Acute Kidney Injury/therapy
• Hepatorenal Syndrome/diagnosis
• Hepatorenal Syndrome/etiology
• Hepatorenal Syndrome/therapy
• Humans
• Liver Cirrhosis/complications
• Renal Replacement Therapy/adverse effects
• Vasoconstrictor Agents/therapeutic use

• AKI
• cirrhosis
• critical care
• dialysis
• epidemiology

• acute kidney injury
• cirrhosis
• hepatorenal syndrome
• mortality
• predictors

• AKI score
• Biliary atresia
• Children
• Cystatin C
• Urinary NGAL

• Chronic Liver Failure Consortium-Sequential Organ Failure Assessment
• Cirrhosis
• Extrahepatic organ failure
• Model for End-stage Liver Disease
• Mortality
• Organ replacement therapy
• Prognostic scores
• Sequential Organ Failure Assessment

• ACLF
• SIRS
• cholemic nephrosis
• lactate
• multidrug resistant infections
• terlipressin dialysis

• Adult
• Esophageal and Gastric Varices
• Gastrointestinal Hemorrhage
• Hospital Mortality
• Hospitalization
• Hospitals
• Humans
• Length of Stay
• Non-alcoholic Fatty Liver Disease/complications
• Non-alcoholic Fatty Liver Disease/epidemiology
• Renal Insufficiency/epidemiology
• Retrospective Studies
• United States/epidemiology

Acute kidney injury (AKI) occurs frequently after liver transplant surgery and is associated with significant morbidity and mortality. While the impact of intraoperative hypotension (IOH) on postoperative AKI has been well demonstrated in patients undergoing a wide variety of non-cardiac surgeries, it remains poorly studied in liver transplant surgery. We tested the hypothesis that IOH is associated with AKI following liver transplant surgery.

This historical cohort study included all patients who underwent liver transplant surgery between 2014 and 2019 except those with a preoperative creatinine > 1.5 mg/dl and/or who had combined transplantation surgery. IOH was defined as any mean arterial pressure (MAP) < 65 mmHg and was classified according to the percentage of case time during which the MAP was < 65 mmHg into three groups, based on the interquartile range of the study cohort: “short” (Quartile 1, < 8.6% of case time), “intermediate” (Quartiles 2–3, 8.6–39.5%) and “long” (Quartile 4, > 39.5%) duration. AKI stages were classified according to a “modified” “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria. Logistic regression modelling was conducted to assess the association between IOH and postoperative AKI. The model was run both as a univariate and with multiple perioperative covariates to test for robustness to confounders.

Of the 205 patients who met our inclusion criteria, 117 (57.1%) developed AKI. Fifty-two (25%), 102 (50%) and 51 (25%) patients had short, intermediate and long duration of IOH respectively. In multivariate analysis, IOH was independently associated with an increased risk of AKI (adjusted odds ratio [OR] 1.05; 95%CI 1.02–1.09; P < 0.001). Compared to “short duration” of IOH, “intermediate duration” was associated with a 10-fold increased risk of developing AKI (OR 9.7; 95%CI 4.1–22.7; P < 0.001). “Long duration” was associated with an even greater risk of AKI compared to “short duration” (OR 34.6; 95%CI 11.5-108.6; P < 0.001).

Intraoperative hypotension is independently associated with the development of AKI after liver transplant surgery. The longer the MAP is < 65 mmHg, the higher the risk the patient will develop AKI in the immediate postoperative period, and the greater the likely severity. Anesthesiologists and surgeons must therefore make every effort to avoid IOH during surgery.

• Acute kidney disease
• Chronic kidney disease
• Hemodynamic
• Intraoperative
• Postoperative complications
• Renal failure
• Transplant

• Hospital charges
• ICD-9
• Length of stay
• Mortality
• National inpatient sample

• Acute kidney injury
• Cirrhosis
• Mortality
• Outcomes

• U54 GM104942 NIGMS NIH HHS

To assess factors associated with renal dysfunction (RD) in hepatitis C virus (HCV) cirrhosis, correlate renal parameters with Child-Pugh score (CPS) and find a cut-off value of CPS to determine RD.

It was a cross-sectional study that included 70 cases of liver cirrhosis secondary to HCV from a period of 6 months at Combined Military Hospital, Multan. Diagnosis of HCV was confirmed by serological assay and liver cirrhosis by ultrasonography. CPS was determined and lab reports were taken. Patients were divided into two groups as not having RD (serum creatinine≤1.5 mg/dL) and having RD (serum creatinine≥1.5 mg/dL). Estimated glomerular filtration rate (eGFR) was calculated by chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Data were analyzed using SPSS V.23.0. χ², Kruskal-Wallis test and Pearson coefficient of correlation were applied. ROC curve was drawn to evaluate cut-off value of CPS for the presence of RD. Level of significance was set at p<0.05.

Patients with CP grade B or C develop RD as compared to patients with CP grade A (p=0.000). Mean age, urea, creatinine and eGFR varies significantly among patients who develop RD and patients who do not (p=0.02, p=0.000, p=0.000 and p=0.000, respectively). eGFR negatively correlates with CPS (r=−0.359, p=0.002). Creatinine, urea and ALBI score positively correlates with CPS (r=+0.417, p=0.000; r=+0.757, p=0.000; r=+0.362, p=0.002, respectively).

Ascites and encephalopathy are associated with RD in HCV cirrhosis.

• hepatitis C
• hepatorenal syndrome
• liver cirrhosis

• acute kidney injury
• biomarkers
• cirrhosis
• cystatin C
• neutrophil gelatinase-associated lipocalin

• Acute kidney injury
• cirrhosis
• hepatorenal syndrome
• intensive care unit

• Acute-on-chronic liver failure, ACLF
• Cirrhosis
• Critical care
• Immune dysfunction
• Organ dysfunction

• Adult
• Aged
• Female
• Glomerular Filtration Rate
• Humans
• Kidney/physiopathology
• Liver/physiopathology
• Liver Cirrhosis/mortality
• Liver Cirrhosis/physiopathology
• Male
• Metabolomics
• Middle Aged
• Severity of Illness Index

• K23 DK089008 NIDDK NIH HHS
• P30 AG028747 NIA NIH HHS
• P30 DK056338 NIDDK NIH HHS
• R01 DK111522 NIDDK NIH HHS

• Cirrhosis
• Cystatin C
• Hepatorenal Syndrome
• Meta-Analysis
• Terlipressin

• Humans
• Kidney Tubular Necrosis, Acute
• Liver Cirrhosis
• Prognosis
• Proportional Hazards Models
• Retrospective Studies
• Survival Analysis
• acute kidney injury
• acute tubular necrosis
• cirrhosis
• continuous renal replacement therapy
• dialysis
• futility
• hemodialysis
• hepatorenal syndrome
• liver transplantation
• renal dialysis
• renal replacement therapy
• transplant-free survival

• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/mortality
• Acute Kidney Injury/therapy
• Comorbidity
• Female
• Health Status
• Hepatorenal Syndrome/diagnosis
• Hepatorenal Syndrome/mortality
• Hepatorenal Syndrome/therapy
• Humans
• Liver Cirrhosis/diagnosis
• Liver Cirrhosis/mortality
• Liver Cirrhosis/therapy
• Liver Transplantation/adverse effects
• Liver Transplantation/mortality
• Male
• Massachusetts/epidemiology
• Middle Aged
• Renal Dialysis/adverse effects
• Renal Dialysis/mortality
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• Waiting Lists

• K23 DK114526 NIDDK NIH HHS
• K24 DK078772 NIDDK NIH HHS
• K24 DK094872 NIDDK NIH HHS
• R01 DK094486 NIDDK NIH HHS

• albuminuria
• chronic hepatitis B
• chronic kidney disease
• renal function

• ACLF
• acute kidney injury
• cirrhosis
• hepatorenal syndrome

• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/etiology
• Acute Kidney Injury/therapy
• Acute-On-Chronic Liver Failure/complications
• Acute-On-Chronic Liver Failure/therapy
• Animals
• Biomarkers/analysis
• Disease Models, Animal
• Hemoperfusion
• Hepatorenal Syndrome/diagnosis
• Hepatorenal Syndrome/epidemiology
• Hepatorenal Syndrome/etiology
• Hepatorenal Syndrome/therapy
• Humans
• Incidence
• Kidney/pathology
• Kidney/physiopathology
• Liver/physiopathology
• Liver Cirrhosis/complications
• Liver Cirrhosis/therapy
• Liver Transplantation
• Prognosis
• Severity of Illness Index
• Vasoconstrictor Agents/therapeutic use

• Acute kidney injury
• Acute-on-chronic liver failure
• Critical care outcomes
• Prognosis
• Risk factors

• cirrhosis
• decompensated cirrhosis
• glomerular filtration rate
• renal function

• Adult
• Aged
• Biomarkers/blood
• Chromium
• Creatinine/blood
• Cystatins/blood
• Edetic Acid
• Female
• Glomerular Filtration Rate
• Humans
• Liver Cirrhosis/diagnosis
• Liver Function Tests/methods
• Male
• Mathematics/methods
• Middle Aged

• Acute kidney injury
• Hepatorenal syndrome
• Liver cirrhosis
• Portal hypertension

In the past decades liver transplantation (LT) has become the treatment of choice for patients with end stage liver disease (ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of a greater number of marginal donors such as older donors or donors after circulatory death (DCD). The improved survival of transplanted patients has increased the frequency of long-term complications, in particular chronic kidney disease (CKD). Acute kidney injury (AKI) post-LT has been recently recognized as an important risk factor for the occurrence of de novo CKD in the long-term outcome. The onset of AKI post-LT is multifactorial, with pre-LT risk factors involved, including higher Model for End-stage Liver Disease score, more sever ESLD and pre-existing renal dysfunction, either with intra-operative conditions, in particular ischaemia reperfusion injury responsible for post-reperfusion syndrome (PRS) that can influence recipient’s morbidity and mortality. Post-reperfusion syndrome-induced AKI is an important complication post-LT that characterizes kidney involvement caused by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since pre-LT risk factors may influence intra-operative events responsible for PRS-induced AKI, we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI. A PubMed search was conducted using the terms liver transplantation AND acute kidney injury; liver transplantation AND post-reperfusion syndrome; acute kidney injury AND post-reperfusion syndrome; acute kidney injury AND DCD AND liver transplantation. Five hundred seventy four articles were retrieved on PubMed search. Results were limited to title/abstract of English-language articles published between 2000 and 2015. Twenty-three studies were identified that specifically evaluated incidence, risk factors and outcome for patients developing PRS-induced AKI in liver transplantation. In order to identify intra-operative risk factors/mechanisms specifically involved in PRS-induced AKI, avoiding confounding factors, we have limited our study to “acute kidney injury AND DCD AND liver transplantation”. Accordingly, three out of five studies were selected for our purpose.

• Liver transplantation
• Acute kidney injury
• Post-reperfusion syndrome
• Donation after circulatory death
• Chronic kidney disease

• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/etiology
• Acute Kidney Injury/mortality
• Animals
• Donor Selection
• End Stage Liver Disease/diagnosis
• End Stage Liver Disease/mortality
• End Stage Liver Disease/surgery
• Graft Survival
• Humans
• Liver Transplantation/adverse effects
• Liver Transplantation/mortality
• Reperfusion Injury/diagnosis
• Reperfusion Injury/etiology
• Reperfusion Injury/mortality
• Risk Factors
• Syndrome
• Tissue Donors/supply & distribution
• Treatment Outcome

• Aged
• Female
• Humans
• Kidney Function Tests
• Liver Cirrhosis/mortality
• Liver Cirrhosis/physiopathology
• Male
• Middle Aged
• Proportional Hazards Models

To propose several alternatives treatment of type 1 hepatorenal syndrome (HRS-1) what is the most severe expression of circulatory dysfunction on patients with portal hypertension.

A group of eleven gastroenterologists and nephrologists performed a structured analysis of available literature. Each expert was designated to review and answer a question. They generated draft statements for evaluation by all the experts. Additional input was obtained from medical community. In order to reach consensus, a modified three-round Delphi technique method was used. According to United States Preventive Services Task Force criteria, the quality of the evidence and level of recommendation supporting each statement was graded.

Nine questions were formulated. The available evidence was evaluated considering its quality, number of patients included in the studies and the consistency of its results. The generated questions were answered by the expert panel with a high level of agreement. Thus, a therapeutic algorithm was generated. The role of terlipressin and norepinephrine was confirmed as the pharmacologic treatment of choice. On the other hand the use of the combination of octreotide, midodrine and albumin without vasoconstrictors was discouraged. The role of several other options was also evaluated and the available evidence was explored and discussed. Liver transplantation is considered the definitive treatment for HRS-1. The present consensus is an important effort that intends to organize the available strategies based on the available evidence in the literature, the quality of the evidence and the benefits, adverse effects and availability of the therapeutic tools described.

Based on the available evidence the expert panel was able to discriminate the most appropriate therapeutic alternatives for the treatment of HRS-1.

• Hepatorenal syndrome
• Delphi
• Consensus
• Evidence-based medicine
• Treatment

• Ascites
• Hepatitis
• Kidney diseases
• Liver diseases
• Peritonitis

• TIPS placement
• Transjugular intrahepatic portosystemic shunt (TIPS)
• cirrhosis
• estimated glomerular filtration rate (eGFR)
• kidney
• large-volume paracentesis (LVP)
• liver
• mortality
• portal hypertension
• refractory ascites
• renal function

• Acute kidney injury
• Cirrhosis
• Dialysis
• Mortality

• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/etiology
• Acute Kidney Injury/mortality
• Acute Kidney Injury/therapy
• Adult
• Aged
• Female
• Hospitalization/statistics & numerical data
• Humans
• Incidence
• Liver Cirrhosis/complications
• Liver Cirrhosis/epidemiology
• Liver Cirrhosis/mortality
• Liver Cirrhosis/therapy
• Male
• Middle Aged
• Renal Dialysis/mortality
• Renal Dialysis/statistics & numerical data
• United States/epidemiology
• Young Adult

• acute kidney failure
• acute kidney injury
• ascites
• cirrhosis
• liver cirrhosis

Acute renal failure, now termed acute kidney injury (AKI), is frequently found in patients with cirrhosis. The occurrence of AKI, irrespective of the underlying cause, is associated with reduced in-hospital, 3-mo and 1-year survival. Hepatorenal syndrome is associated with the worst outcome among AKI patients with cirrhosis. Several definitions for AKI that have been proposed are outlined and evaluated in this paper. Among these, the International Club for Ascites-AKI criteria substantially strengthen the quality of early diagnosis and intervention according to underlying cause of AKI.

• Renal failure
• End-stage liver disease
• Acute kidney injury
• Hepatorenal syndrome
• Liver cirrhosis

• Acute kidney injury
• Biomarkers
• Cirrhosis
• Differential diagnosis
• Prognosis