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Abstract: TH-PO053

Outcomes of AKI on CKD in Hospitalized Cirrhotic Patients: Data from the HRS-HARMONY Consortium

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • St. Hillien, Shelsea A., Mass General Brigham Inc, Boston, Massachusetts, United States
  • Belcher, Justin Miles, Yale School of Medicine, New Haven, Connecticut, United States
  • Ouyang, Tianqi, Mass General Brigham Inc, Boston, Massachusetts, United States
  • Robinson, Jevon E., Mass General Brigham Inc, Boston, Massachusetts, United States
  • Regner, Kevin R., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Velez, Juan Carlos Q., Ochsner Health, New Orleans, Louisiana, United States
  • Patidar, Kavish Rohit, Baylor College of Medicine, Houston, Texas, United States
  • Cullaro, Giuseppe, University of California San Francisco School of Medicine, San Francisco, California, United States
  • Chung, Raymond T., Mass General Brigham Inc, Boston, Massachusetts, United States
  • Allegretti, Andrew S., Mass General Brigham Inc, Boston, Massachusetts, United States

Group or Team Name

  • HRS-HARMONY Consortium.
Background

The frequency of chronic kidney disease (CKD) is increasing in cirrhosis and these patients frequently suffer acute kidney injury (AKI). Direct comparisons of outcomes between AKI vs AKI on CKD are not well described in cirrhosis.

Methods

2,057 cirrhotic patients with AKI across 11 hospital networks from the HRS-HARMONY consortium were analyzed (70% AKI without CKD and 30% AKI on CKD). Primary outcome was unadjusted and adjusted 90-day mortality, with transplant as a competing risk.

Results

Compared to patients without CKD, patients with AKI on CKD had higher admission creatinine (2.24 [IQR 1.7, 3.18] vs 1.83 [1.38, 2.58] mg/dL) and peak creatinine (2.79 [2.12, 4] vs 2.42 [1.85, 3.50] mg/dL) but better synthetic liver function (total bilirubin 1.5 [IQR 0.7, 3.1] vs 3.4 [1.5, 9.3] mg/dL; and INR 1.4 [IQR 1.2, 1.8] vs 1.7 [1.39, 2.2]; p<0.001 for all). Patients with AKI on CKD were more likely to have NASH cirrhosis (31% vs 17%) and less likely to have alcohol-associated liver disease (26% vs 45%; p<0.001 for all). Patients without CKD had higher unadjusted mortality (39% vs 30%), intensive care unit admission (52% vs 35%), and use of renal replacement therapy (29% vs 15%; p<0.001 for all). After adjusting for age, race, sex, transplant listing status and MELD-Na score; AKI on CKD was associated with a lower 90-day mortality compared to AKI without CKD (sub-HR 0.73 [95% CI 0.61, 0.88]).

Conclusion

In cirrhotic hospitalized patients, AKI on CKD is associated with lower 90-day mortality compared to AKI without CKD. This surprising finding may be due to worse synthetic liver function in the AKI without CKD group as underlying liver function is a strong driver of short-term outcomes in this population. Further study of the complicated interplay between acute and chronic kidney disease in cirrhosis is needed.