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Kidney Week

Abstract: TH-PO051

Association of AKI-Hepatorenal Syndrome (HRS) with Mortality in Hospitalized Cirrhotic Patients Requiring Renal Replacement Therapy: Results from the HRS-HARMONY Consortium 

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Cama-Olivares, Augusto, The University of Alabama at Birmingham Division of Nephrology, Birmingham, Alabama, United States
  • Ouyang, Tianqi, Massachusetts General Hospital Division of Nephrology, Boston, Massachusetts, United States
  • Takeuchi, Tomonori, The University of Alabama at Birmingham Division of Nephrology, Birmingham, Alabama, United States
  • St. Hillien, Shelsea A., Massachusetts General Hospital Division of Nephrology, Boston, Massachusetts, United States
  • Robinson, Jevon E., Massachusetts General Hospital Division of Nephrology, Boston, Massachusetts, United States
  • Patidar, Kavish Rohit, Indiana University School of Medicine Division of Gastroenterology and Hepatology, Indianapolis, Indiana, United States
  • Cullaro, Giuseppe, University of California San Francisco Division of Gastroenterology, San Francisco, California, United States
  • Chung, Raymond T., Massachusetts General Hospital Division of Gastroenterology, Boston, Massachusetts, United States
  • Regner, Kevin R., Medical College of Wisconsin Division of Nephrology, Milwaukee, Wisconsin, United States
  • Velez, Juan Carlos Q., Ochsner Medical Center Department of Nephrology, New Orleans, Louisiana, United States
  • Wahid, Nabeel, Northwestern University Feinberg School of Medicine Division of Gastroenterology and Hepatology, Chicago, Illinois, United States
  • Sharma, Pratima, University of Michigan Health System Department of Gastroenterology and Transplant Hepatology, Ann Arbor, Michigan, United States
  • Allegretti, Andrew S., Massachusetts General Hospital Division of Nephrology, Boston, Massachusetts, United States
  • Neyra, Javier A., The University of Alabama at Birmingham Division of Nephrology, Birmingham, Alabama, United States
  • Belcher, Justin Miles, Yale University Department of Internal Medicine, New Haven, Connecticut, United States

Group or Team Name

  • HRS-HARMONY Consortium.
Background

While AKI-RRT is associated with mortality in heterogeneous inpatient populations, the epidemiology of AKI-RRT in hospitalized cirrhotic patients is not fully known. Herein, we evaluated the association of etiology of AKI with mortality in hospitalized cirrhotic patients with AKI-RRT.

Methods

This is a multicenter retrospective cohort study using data from the HRS-HARMONY consortium which included 15 hospitals in the U.S. (01/2019-12/2019). Consecutive hospitalized adult (≥18 years) cirrhotic patients with AKI-RRT were included in this study. The primary outcome was 90-day mortality and the main independent variable was AKI etiology, classified as hepatorenal syndrome (HRS-AKI) vs. other. AKI etiology was adjudicated by at least 2 independent adjudicators. We performed multivariate Cox regression analysis adjusting for age, gender, race, transplant listing status, MELD-Na score, requirement of CRRT, pressor use, and study site.

Results

Of 2063 hospitalized cirrhotic patients with AKI, 374 (18.1%) had AKI-RRT. Among these, 65 (17.4%) had HRS-AKI and 309 (82.6%) had other etiologies of AKI which included ATN in the majority of cases (62.6%). The HRS-AKI (vs. other AKI etiology) group required less CRRT than hemodialysis as the initial RRT modality (56.9% vs. 73.9%, p=0.006), more HRS vasoconstrictor use (81.5% vs. 67.9%, p=0.03), and less mechanical ventilation use (50.8% vs. 64.3%, p=0.04). In a fully adjusted model, HRS-AKI (vs. other AKI etiology) was not associated with 90-day mortality (aHR=1.16, 95% CI: 0.75-1.79, p=0.51). Clinical parameters independently associated with 90-day mortality included liver transplant listing (aHR=0.22, 95% CI: 0.14-0.35), MELD-Na score (aHR=1.04, 95% CI: 1.02-1.05), and the need of CRRT (aHR=2.64, 95% CI: 1.68-4.13).

Conclusion

Among hospitalized adult cirrhotic patients with AKI-RRT, HRS-AKI was diagnosed in about one-fifth of patients, but did not confer an independent increased risk of 90-day mortality when compared to other AKI etiologies. Higher MELD-Na score and the need of CRRT were independently associated with increased 90-day mortality in this susceptible population.