Acute kidney disease tied to poor survival, CKD in patients with cirrhosis, AKI

One in three hospitalized patients with cirrhosis and acute kidney injury (AKI) develop acute kidney disease (AKD), which is associated with worse survival and de novo chronic kidney disease (CKD), reveals a recent study. Interventions targeting AKD may improve outcomes of these patients.

In this study, the authors evaluated a total of 6,250 hospitalized patients with cirrhosis and AKI in the Center-Health-Facts database from January 2009 to September 2017 for AKD and followed them for 180 days. AKI and AKD were defined based on Kidney Disease: Improving Global Outcomes (KDIGO) and Acute Disease Quality Initiative (ADQI) AKD and renal recovery consensus criteria, respectively.

Mortality was the primary outcome, while de novo CKD was secondary. The authors used competing-risk multivariable models to determine the independent association of AKD with primary and secondary outcomes.

Thirty-two percent of the patients developed AKD. Multivariate analysis adjusted for significant confounders revealed a higher mortality risk among patients with AKD at 90 (subdistribution hazard ratio [sHR], 1.37, 95 percent confidence interval [CI], 1.14‒1.66; p=0.001) and 180 days (sHR, 1.37, 95 percent CI, 1.14‒1.64; p=0.001).

De novo CKD had an incidence rate of 37.5 percent. Patients with AKD were more likely to develop de novo CKD than those without (64.0 percent vs 30.7 percent; p<0.001). On multivariable competing-risk analysis adjusted for confounders, AKD independently correlated with de novo CKD (sHR, 2.52, 95 percent CI, 2.01‒3.15; p<0.001).

“AKD is the persistence of AKI for up to 3 months, which is proposed to be the time-window where critical interventions can be initiated to alter downstream outcomes of AKI,” the authors said.