Abstract: FR-PO0125
Outcomes of Acute Tubular Necrosis in Hospitalized Patients with Cirrhosis: Results from the HRS-HARMONY Consortium
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
- Belcher, Justin Miles, Yale University, New Haven, Connecticut, 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, Houston Methodist Hospital, Houston, Texas, United States
- Neyra, Javier A., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Asrani, Sumeet, Baylor Scott & White Health, Dallas, Texas, United States
- Simonetto, Douglas A, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Wadei, Hani, Mayo Clinic in Florida, Jacksonville, Florida, United States
- Allegretti, Andrew S., Massachusetts General Hospital, Boston, Massachusetts, United States
Background
Hospitalized patients with cirrhosis often suffer from acute kidney injury (AKI) of multiple etiologies. While many studies have sought to characterize outcomes of patients with hepatorenal syndrome (HRS), none have specifically investigated acute tubular necrosis (ATN). Herein, we investigate factors associated with outcomes in patients with cirrhosis and ATN.
Methods
This is a multicenter retrospective cohort study using data from the HRS-HARMONY research collaboration derived from 15 hospitals in the U.S. from January 2019-December 2019. Consecutive hospitalized adult (≥18 years) patients with cirrhosis and AKI were included. The primary outcome was 90-day mortality with secondary outcomes of AKI recovery, requirement for renal replacement (RRT) and respiratory failure. AKI etiology was adjudicated by at least 2 independent adjudicators. We constructed multivariate Fine-Gray sub-hazard models adjusting for age, gender, race, transplant listing status, MELD-Na score, HRS-vasoconstrictor use and ICU admission, with liver transplant receipt considered a competing risk.
Results
Of 2,063 patients with AKI, 628 (30.4%) had ATN. Among these, 331 (52.7%) died within 90 days. Survival decreased with peak AKI stage and increased with partial (sHR=2.89, 95% CI 1.83-4.58) and complete (sHR=4.99, 95% CI, 3.41-7.29) recovery. Age, MELD-Na score, lack of AKI recovery, ICU admission and respiratory failure were independently associated with increased mortality while Hispanic race, baseline chronic kidney disease and liver transplant listing were associated with decreased mortality. 234/628 (37.3%) patients received RRT. Overall mortality among those receiving RRT was 65.8% and was higher for those initiated on continuous RRT, 131/175 (74.8%), than intermittent RRT, 43/95 (45.3%), p <0.001. Patients listed for transplant were more likely to receive RRT, (sHR=2.51, 95% CI: 1.40-4.57).
Conclusion
Among hospitalized adult patients with cirrhosis and AKI, ATN was diagnosed in around one-third of patients. Patients listed for transplant were more likely to be dialyzed but had greater 90-day survival. Requirement for RRT was associated with high mortality but 34% of patients survived to 90 days.