Chronic kidney disease risk elevated in AKI survivors with cirrhosis

Cirrhotic survivors of acute kidney injury (AKI) are likely to develop chronic kidney disease (CKD), which, in turn, worsens outcomes, a recent study has found.

The study included 409 patients admitted for cirrhosis complications. Most (n=241; mean age, 60±12 years; 61 percent male) were without AKI, while 168 (mean age, 60±10 years; 81 percent male) had the condition. The endpoint was CKD development, defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m² 3 months after AKI diagnosis.

In the AKI group, 97 were available for follow-up at 3 months; the other 58 had died, eight had received transplants and five were lost to attrition. In the remaining AKI patients, 25 percent (n=24) were diagnosed with CKD, with a median eGFR of 47 mL/min/1.73 m². The remaining 73 were free of the chronic condition.

In comparison, only 1 percent (n=2) of the remaining non-AKI comparison group developed CKD over the same time span. This resulted in a significantly greater risk estimate for AKI patients (odds ratio [OR], 31, 95 percent confidence interval [CI], 7–133; p<0.0001).

Multivariate analysis further confirmed the significant effect of nosocomial AKI (OR, 5.1, 95 percent CI, 1.7–15.2; p=0.003), as well as AKI stage 1B or greater (OR, 6.0, 95 percent CI, 1.7–21.2; p=0.005) on the risk of developing CKD.

In turn, the researchers found that CKD significantly increased the frequency of AKI episodes in the subsequent follow-up, as well as the incidence of bacterial infections, portal hypertension-related bleeding and hospital readmissions.