Abstract: FR-PO0118
Revisiting Precipitating Factors Associated with Hepatorenal Syndrome
Session Information
- AKI: Epidemiology and Clinical Trials
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Punukollu, Pooja A., UQ-Ochsner Clinical School, New Orleans, Louisiana, United States
- Shuaibi, Sameera Nadine, Ochsner Health, New Orleans, Louisiana, United States
- Chachad, Ravi, UQ-Ochsner Clinical School, New Orleans, Louisiana, United States
- Velez, Juan Carlos Q., Ochsner Health, New Orleans, Louisiana, United States
Background
In patients with advanced cirrhosis, spontaneous bacterial peritonitis (SBP) is largely regarded as the most common precipitating factor for the development of acute kidney injury (AKI) due to hepatorenal syndrome (HRS). However, acute-on-chronic liver failure (ACLF) has been increasingly recognized as a common trigger. Thus, we aimed to re-examine the clinical events preceding an episode of AKI due to HRS.
Methods
In a prospective observational cohort of AKI in cirrhosis, we searched for patients who met the ICA criteria for HRS, had a urinary sodium < 20 mEq/L, were treated with a vasoconstrictor (VC) [midodrine/octreotide (M/O), norepinephrine (NE) or terlipressin (T)], and achieved a minimum of 5 mmHg of rise in mean arterial pressure, over a 7-year period. We collected the reason for hospital admission to determine the potential HRS precipitating factor. For ACLF, we specifically searched for those presenting with new-onset jaundice, newly elevated serum bilirubin and/or acute alcoholic hepatitis.
Results
A total of 76 patients with HRS treated with a VC (58 NE, 14 T, 4 M/O) were included (39% women, mean age 51, sCr 3.8 mg/dL, MELD 31.9). The most common precipitating factor was refractory ascites which was present as the primary driver for the hospitalization in 27 (36%) patients (most patients presented with increased abdominal girth despite increasingly frequent paracentesis), followed by ACLF in 20 (26%). The third most common triggering event was hepatic encephalopathy, present in 10 (13%) patients. Unexpectedly, direct hospitalization from clinic due to a low serum sodium was the precipitating event in 6 (8%), the fourth most common cause. SBP only accounted for 4 (5%) cases, same incidence as gastrointestinal bleeding. Non-SBP infections accounted for 4 (5%) cases, thus, infections as a whole accounted for 8 (10%) cases. Other precipitating factors accounting for 1 case each included hepatic hydrothorax and portal vein thrombosis.
Conclusion
Refractory ascites is the most common precipitating factor preceding AKI due to HRS, likely reflecting a progressive state of worsening portal hypertension, followed by ACLF / new-onset jaundice. Severe hyponatremia may be considered as a novel independent factor associated with the development of HRS, whereas SBP may not be as common trigger as previously reported.