Prospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2018; 24(21): 2300-2310
Published online Jun 7, 2018. doi: 10.3748/wjg.v24.i21.2300
Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis
Qun-Qun Jiang, Mei-Fang Han, Ke Ma, Guang Chen, Xiao-Yang Wan, Semvua Bukheti Kilonzo, Wen-Yu Wu, Yong-Li Wang, Jie You, Qin Ning
Qun-Qun Jiang, Mei-Fang Han, Ke Ma, Guang Chen, Xiao-Yang Wan, Semvua Bukheti Kilonzo, Wen-Yu Wu, Yong-Li Wang, Jie You, Qin Ning, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Author contributions: Jiang QQ designed the study, performed the experiments, analyzed the data, and drafted the manuscript; Wu WY, Wang YL, Jie Y enrolled the patients and collected clinical data; Ning Q, Han MF, Ma K, Wan XY and Chen G designed the study and revised the manuscript; and Kilonzo SB revised the manuscript.
Supported by the Innovation Team Development Plan of the Ministry of Education, No. IRT_14R20; and National Natural Science Foundation of China, No. 81571989.
Institutional review board statement: The study was approved by the ethics committee of Tongji hospital (TJ_C20151108).
Clinical trial registration statement: ChiCTR1800015492.
Informed consent statement: Written informed consents were obtained from all participants or their legal representatives.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Qin Ning, MD, PhD, Professor, Director, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan 430030, Hubei Province, China.
Telephone: +86-27-83662391 Fax: +86-10-85381893
Received: March 27, 2018
Peer-review started: March 28, 2018
First decision: April 19, 2018
Revised: April 28, 2018
Accepted: May 6, 2018
Article in press: May 6, 2018
Published online: June 7, 2018
Research background

Acute kidney injury (AKI) is a common and serious complication of acute-on-chronic liver failure (ACLF) and decompensated cirrhosis (DC). Previous studies have been clearly established that the acute-on-chronic liver failure and decompensated liver cirrhosis are two different diseases.However, the differences in acute kidney injury among patients with these two diseases are rarely studied and whether AKI should be managed in the same way in patients with these two diseases is still uncertain.

Research motivation

Clinically, the treatment of patients with different types of renal impairment is significantly different. A clear clarification on the differences in AKI between ACLF and DC patients will promote timely and more appropriate management of the patients.

Research objectives

This study was conducted to clarify the differences in AKI between hepatitis B virus (HBV)-ACLF and HBV-DC patients, including the differences in the etiology of AKI, natural course, patient’s response to terlipressin and prognosis.

Research methods

This study is a prospective observational study, patients with HBV-ACLF and HBV-DC who were admitted to our hospital between 2015.12 and 2017.7 were consecutively recruited. Urine specimens of all patients were collected at the time of admission and when AKI was diagnosed, and the levels of five tubular injury biomarkers in urine were detected. Simultaneously, the demographic data, natural course of AKI, patient’s response to terlipressin treatment and patient outcomes were recorded.

Research results

Patients with ACLF-AKI have significantly higher urinary biomarker levels than those with DC-AKI or without AKI. There was a higher proportion of patients with AKI progression in ACLF-AKI patients than in DC-AKI patients (49.3% vs 17.9%, P = 0.013). Forty-three patients with ACLF-AKI and 19 patients with DC-AKI were treated with terlipressin, the response rate to terlipressin was significantly lower in patients with ACLF-AKI than in patients with DC-AKI (32.6% vs 57.9%, P = 0.018). In addition, patients in the ACLF-AKI group had the lowest survival rate at 90 d among all groups (P < 0.001).

Research conclusions

Our study demonstrated that AKI in patients with HBV-ACLF is distinct different from in HBV-DC patients.In HBV-ACLF patients, AKI is more likely to be caused by structural damages and tends to be more progressive, with a poorer response to terlipressin and a worse prognosis than in HBV-DC patients.

Research perspectives

Our results suggest that AKI occurring in patients with HBV-ACLF or HBV-DC should be managed in different ways. Large-scale multi-center studies are required to validate these findings, and the differences in AKI between patients with ACLF and DC caused by other etiologies still need to be further studied.