Table 3.
Recent studies on AKI in cirrhosis
| First author (publication year) | Patient population | Type of study | Diagnostic criteria | Major findings |
|---|---|---|---|---|
| Warner et al. [27] (2011) | Admitted cirrhotic patients with ascites & SCr >1.5 mg/dL | Retrospective | AKIN & traditional | N=152 |
| Prevalence of AKI: 70% | ||||
| AKI plus CKD: 17% | ||||
| Pre-renal azotemia: 69% of all AKI | ||||
| HRS-1: 9% | ||||
| Hospital mortality for AKI: 34% | ||||
| de Carvalho et al. [28] (2012) | Admitted cirrhotic patients with ascites | Retrospective | AKIN | N=198 |
| Prevalence of AKI: 41% | ||||
| Hazard ratio for in-hospital mortality is 2.6 | ||||
| Altamirano et al. [15] (2012) | Admitted patients with alcoholic hepatitis | Retrospective | AKIN | N=103 |
| Prevalence of AKI: 28% | ||||
| 90 day mortality in AKI patients 65% vs. 7% in non-AKI patients | ||||
| Tsien et al. [17] (2013) | Stable cirrhotic outpatients with ascites | Prospective | IAC & ADQI | N=90 |
| Prevalence of AKI: 54% | ||||
| 30 month survival was 78% in AKI group vs. 93% in non-AKI group (P =0.049) | ||||
| Belcher et al. [13] (2013) | Admitted cirrhotic patients with ascites and AKI | Prospective | AKIN | N=198 |
| Progression of AKI: 44% | ||||
| Progression was associated with a marked increase in in-hospital mortality | ||||
| Wong et al. [18] (2013) | Admitted cirrhotic patients with ascites and infection | Prospective | IAC & ADQI | N=337 |
| Prevalence of AKI: 49% | ||||
| 30-day mortality for AKI non recovery: 80%; | ||||
| for AKI recovery: 15%; | ||||
| for non-AKI patients: 7% | ||||
| Fagundes et al. [29] (2013) | Admitted cirrhotic patients with complications | Prospective | AKIN | N=375 |
| Prevalence of AKI: 47% | ||||
| Stage 1 AKI: 77% of all AKI episodes | ||||
| Stage 1a*: 90-day survival same as non AKI patients | ||||
| Gradual decrease in 90-day survival with increasing AKI stage starting from stage 1b** | ||||
| Piano et al. [30] (2013) | Admitted cirrhotic patients | Prospective | AKIN & traditional | N=233 |
| Prevalence of AKI: 26% (AKIN criteria) or 12% (traditional criteria) | ||||
| Traditional criteria better at identifying patients at risk for progression of AKI | ||||
| Scott et al. [16] (2013) | Admitted cirrhotic patients with AKI | Prospective (patients) Retrospective (controls) | AKIN | N=110 (patients) N=52 (controls) |
| Higher baseline SCr in AKI patients | ||||
| Increasing in-hospital mortality with increasing stage of AKI | ||||
| Bucsics et al. [31] (2015) | Cirrhotic patients with ascites undergoing large volume paracentesis | Retrospective | AKIN & modified AKIN for cirrhosis (AKI-1a & 1b**) | N=239 (90% inpatients) |
| Prevalence of AKI: 32.6% (AKIN criteria) | ||||
| Increasing 30-day mortality with increasing stage of AKI | ||||
| Increased mortality also observed in patients with peak SCr <1.5 mg/dL | ||||
| Tandon et al. [19] (2016) | Admitted cirrhotic patients | Retrospective | IAC (2015) | N=8,680 |
| Prevalence of AKI: 39% | ||||
| Increasing 30-day mortality with increasing stage of AKI | ||||
| 3.5 fold increased in mortality also observed in patients with peak SCr <1.5 mg/dL |
ADQI, Acute Dialysis Quality Initiative; AKI, Acute kidney injury; AKI-1a*, stage 1 AKI according to AKIN diagnostic criteria with the final serum creatinine <1.5 mg/dL; AKI-b**, stage 1 AKI according to AKIN diagnostic criteria with the final serum creatinine ≥1.5 mg/dL; AKIN, Acute Kidney Injury Network; CKD, chronic kidney disease; HRS-1, type 1 hepatorenal syndrome; IAC, International Ascites Club; SCr, serum creatinine.