Abstract: FR-PO143

Outcome of Decompensated Liver Cirrhosis Patients with AKI Treated with Renal Replacement Therapy

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Li, Jian, Henry Ford Hospital, Detroit, Michigan, United States
  • Yessayan, Lenar Tatios, University of Michigan, Ann Arbor, Michigan, United States
  • Soman, Sandeep S., Henry Ford Hospital, Detroit, Michigan, United States
Background

Acute kindey injury(AKI) is a common complication in patients with cirrhosis and is associated with high mortality, renal repalcement therapy(RRT) is considered futile in hepatorenal syndrome if patient is not liver transplant candidate. The over survival and predictive factors has not been well established in those patients.

Methods

We retrospectively identified 123 patients with decompensated Liver cirrhosis receiving RRT for AKI between Nov. 1, 2013 and Dec. 31, 20015 in our hospital. Diagnosis of decompensated liver cirrhosis was based on previous histology findings or on various associations of clinical, biological, endoscopic, and/or imaging findings; AKI and HRS diagnosis were based on KDIGO and International Ascites Club 2007 criteria. The initiation of RRT was determined by nephrologist based on routine practice indications with assent of intensivist or hepatologist involved the care. RRT modality includes SLED-RCA, CVVH or IHD. Death served as outcome. 1, 3 and 6 month’s mortality and selected clinical characteristics were examined. Chi-square two-sided tests were used to compare categorical variables, t test used for numerical data, P<0.05 is statistical significant.

Results

In this cohort, 52.8% was male; age 53.3 ±11.6; AKI causes: HRS 65; ATN 54, others 4. in 123 patients, Cirrhosis causes: alcohol 79, NSAH 18, hepatitis C and B: 10 and 1, others 15. 121 patients had outcome data, 2 patients lost follow up. In the death group, 1, 3 and 6 month’s mortality rate was: 84.9%; 97.2% and 100%, average time on RRT were 20 ±30 days. In the 15 patients who survived till the time of transplanted, remained or off RRT, their average time on dialysis was 114 ± 106 days; 7 had simultaneous liver and kidney, 2 had liver transplant and off RRT, other 5 patients recovered or with CKD3, one was HD dependent. ICU admission, sepsis, infection and ventilator support were much higher in non-survival patients vs survival patients (P<0.0007-0.03). MELD score no difference in two groups, but all patients had higher score at time of RRT than at admission (P<0.01).

Conclusion

Patients with RRT dependent AKI in decompensated liver cirrhosis had very high short and long term mortality if they were not a liver transplant candidate. ICU admission, sepsis, infection and ventilator support rates were much higher in non-survival group than survived group.