Abstract: TH-PO0766
Does Etiology of AKI Matter in End-Stage Liver Disease? A Retrospective Single-Center Cohort Study
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
- Agrawal, Vikas, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Jan, Muhammad Yahya, Indiana University School of Medicine, Indianapolis, Indiana, United States
Background
AKI is common in end-stage liver disease (ESLD) and a leading mortality predictor. Traditional management relies on etiologic classification- prerenal, hepatorenal (HRS-AKI), and acute tubular necrosis (ATN), but emerging data suggest ATN and HRS-AKI carry similar mortality risk, challenging this framework. We hypothesize that AKI severity and transplant access are more consequential than etiology alone.
Methods
Single-center retrospective study of adults admitted with AKI in the setting of ESLD at Indiana University Hospital (January-June2023), excluding acute liver failure. AKI was defined and staged per International Ascites Club criteria and classified as prerenal, ATN, HRS-AKI, or multifactorial. Primary outcome was liver transplant status (OLT); secondary outcomes included mortality, hospital discharge, and dialysis dependence at 28 days.
Results
Of 268 charts reviewed, 144 patients were included (52.8% male, 92.4% White, mean BMI 30.3 kg/m2). Creatinine rose from 1.05 to a peak of 3.06 mg/dL; 43 patients (29.9%) required dialysis. Mortality rose sharply with AKI stage. By etiology, mortality was highest in ATN, followed by multifactorial, HRS-AKI, and prerenal. Dialysis rates were highest in HRS-AKI and ATN. OLT rates were comparable across stages and etiologies (~10-20%), with 94.1% (16 of 17) recipients surviving past 90 days post-transplant.
Conclusion
AKI stage was strongly associated with 28-day mortality. Despite higher dialysis rates, HRS-AKI showed lower mortality than ATN, suggesting renal replacement therapy may serve as a meaningful survival bridge. OLT recipients demonstrated excellent 90-day survival, underscoring transplant as the definitive determinant of long-term outcomes. These findings suggest etiology alone is insufficient for prognostication - AKI stage, trajectory, and transplant access are the critical outcome drivers.
Clinical Outcomes by AKI Stage and Etiology (n=144)
| AKI Stage | N (%) | Death, n (%) | Discharged, n (%) | Required Dialysis, n (%) | Transplant, n (%) | Alive on Dialysis, n (%) |
| Stage 1 | 45 (31.2%) | 4 (8.9%) | 32 (71.1%) | 6 (13.3%) | 9 (20.0%) | 0 (0.0%) |
| Stage 2 | 45 (31.2%) | 15 (33.3%) | 26 (57.8%) | 13 (28.9%) | 2 (4.4%) | 2 (4.4%) |
| Stage 3 | 54 (37.5%) | 32 (59.3%) | 11 (20.4%) | 24 (44.4%) | 6 (11.1%) | 5 (9.3%) |
| Total | 144 (100%) | 51 (35.4%) | 69 (47.9%) | 43 (29.9%) | 17 (11.8%) | 7 (4.9%) |
| Pre-renal | 72 (50.0%) | 12 (16.7%) | 51 (70.8%) | 10 (13.9%) | 9 (12.5%) | 0 (0.0%) |
| ATN | 33 (22.9%) | 21 (63.6%) | 6 (18.2%) | 15 (45.5%) | 4 (12.1%) | 2 (6.1%) |
| HRS-AKI | 17 (11.8%) | 7 (41.2%) | 5 (29.4%) | 9 (52.9%) | 2 (11.8%) | 3 (17.6%) |
| Multifactorial | 22 (15.3%) | 11 (50.0%) | 7 (31.8%) | 9 (40.9%) | 2 (9.1%) | 2 (9.1%) |
Alive on dialysis=Patient discharged alive requiring ongoing dialysis