Kidney Week

Abstract: TH-PO0764

Burden and Outcomes of AKI, Including Hepatorenal Syndrome, Among Hospitalized Patients with Cirrhosis: A Nationwide Analysis

Session Information

• AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Ghimire, Manoj, Baylor College of Medicine, Houston, Texas, United States

Manoj Ghimire, MD

• Poudel, Sajana, The University of Texas MD Anderson Cancer Center Gastrointestinal Cancer Center, Houston, Texas, United States

Sajana Poudel, MD

• Ghimire, Kalpana, University of Illinois Chicago, Chicago, Illinois, United States

Kalpana Ghimire, MD

• Shrestha, Karun, Medical College of Wisconsin Department of Medicine, Milwaukee, Wisconsin, United States

Karun Shrestha, MD

• Subedi, Prakriti, Medical College of Wisconsin Department of Medicine, Milwaukee, Wisconsin, United States

Prakriti Subedi, MD

• Pandey, Oshna, St Barnabas Hospital, New York, New York, United States

Oshna Pandey, MD, MBBS

• Blanco Montecino, Ronald M., St Barnabas Hospital, New York, New York, United States

Ronald M. Blanco Montecino, MD

• Flores Chang, Bessy Suyin, St Barnabas Hospital, New York, New York, United States

Bessy Suyin Flores Chang, MD, FASN

Background

Acute kidney injury (AKI), including hepatorenal syndrome (HRS), is a common and serious complication of cirrhosis associated with significant morbidity and mortality. However, large-scale data comparing the clinical characteristics, management patterns, and outcomes of HRS-associated AKI (HRS-AKI) and non-HRS AKI in cirrhosis are limited. We aimed to compare the incidence and outcomes of HRS-AKI versus non-HRS AKI among hospitalized patients with cirrhosis using a nationwide database.

Methods

We conducted a retrospective cohort study using the 2016–2022 National Inpatient Sample (NIS) database. Adult patients (≥18 years) hospitalized with cirrhosis were included. Demographics, in-hospital complications, resource utilization, and outcomes were compared between patients with AKI with and without HRS.

Results

A total of 5,432,208 adult hospitalizations (age>18) with cirrhosis were identified during the study period, among whom 1,653,839 (30.4%) had AKI. Among patients with AKI, 245,995 (14.87%) had acute tubular necrosis (ATN), 230,255 (14.0%) had HRS-AKI, 1,025 had cortical necrosis, and 260 had medullary necrosis. Compared with non-HRS AKI, patients with HRS-AKI had a higher incidence of cirrhosis-related complications, including hepatic encephalopathy (1.91% vs 0.92%), ascites (27.8% vs 22.17%), spontaneous bacterial peritonitis (13.47% vs 4.15%), variceal bleeding (1.0% vs 0.83%), and gastrointestinal bleeding (18.48% vs 13.4%). Hepatocellular carcinoma was also more prevalent in the HRS-AKI group (6.94% vs 4.53%).
Patients with HRS-AKI required more vasopressor support (4.64% vs 2.52%) and renal replacement therapy (15.67% vs 5.02%). They also underwent renal transplantation (0.56% vs 0.06%) and liver transplantation (3.81% vs 1.34%) more frequently. HRS-AKI was associated with significantly higher in-hospital mortality (25.19% vs 12.43%), longer hospital length of stay (10.95 vs 8.06 days), and higher mean total hospital costs ($163,601 vs $104,675).

Conclusion

HRS-AKI accounts for a substantial proportion of AKI in hospitalized patients with cirrhosis and is associated with significantly worse clinical outcomes, greater healthcare utilization, and increased mortality compared with non-HRS AKI.