Kidney Week

Abstract: SA-PO006

Survival after Initiation of Renal Replacement Therapy for AKI in Cirrhosis

Session Information

• AKI Clinical: Epidemiology and Outcomes
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

• 003 AKI: Clinical and Translational

Authors

• Allegretti, Andrew S., Massachusetts General Hospital , Boston, Massachusetts, United States

Andrew S. Allegretti,

• Parada, Xavier F., Massachusetts General Hospital , Boston, Massachusetts, United States

Xavier F. Parada,

• Eneanya, Nwamaka Denise, Massachusetts General Hospital , Boston, Massachusetts, United States

Nwamaka Denise Eneanya,

• Chung, Raymond T., MGH, Boston, Massachusetts, United States

Raymond T. Chung,

• Thadhani, Ravi I., Massachusetts General Hospital , Boston, Massachusetts, United States

Ravi I. Thadhani,

• Gilligan, Hannah M., Massachusetts General Hospital , Boston, Massachusetts, United States

Hannah M. Gilligan,

Background

Mortality is high after initiation of renal replacement therapy for acute kidney injury in cirrhosis. Literature on the appropriateness of dialysis in hepatorenal syndrome is sparse and is confounded by liver transplant eligibility. An update on outcomes in the non-listed subgroup is needed. Our objective is to compare survival after initiation of renal replacement therapy in cirrhosis between hepatorenal syndrome and acute tubular necrosis, stratifying by liver transplant listing status.

Methods

Retrospective cohort study of patients with cirrhosis acutely initiated on hemodialysis or continuous renal replacement therapy at five hospitals, including one liver transplant center. Multivariable regression and survival analysis were performed.

Results

472 subjects were analyzed, 131 listed and 341 not listed for transplant. 24% (114/472) were alive at six months. Among those who did not receive a transplant, 14% (59/409) were alive at six months. Using stepwise regression, significant predictors of mortality were: non-listed transplant status, MELD score, age, admission to the intensive care unit, serum ALT, mechanical ventilation, and initiation with continuous renal replacement therapy. When stratified by transplant listing, adjusted Cox models showed similar survival between hepatorenal syndrome and acute tubular necrosis (HR 0.81 [95% CI 0.59, 1.11]; p = 0.19 among those not listed; HR 0.73 [95% CI 0.44, 1.19]; p = 0.21 among those listed).

Conclusion

After initiation of renal replacement therapy in cirrhosis, mortality is high at six months. Transplant listing status, MELD score, and indicators of critical illness best predicted mortality. Etiology of acute kidney injury (hepatorenal syndrome versus acute tubular necrosis) was not significantly associated with mortality.

Raw outcomes at six months

Funding

• NIDDK Support