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. 2021 Oct 5;14:385–396. doi: 10.2147/CEG.S323778

Table 2.

Key Issues Requiring Patient Counselling in HRS-AKI

Issue Treatment Options and Role(s) of Clinical Staff Role of Patient and/or Caregiver
Ascites and/or fluid retention
  • Advise dietary modifications, eg, sodium reduction to <2 g/24 h

  • Withhold diuretics

  • Therapeutic paracentesis to control volume/avoid tense ascites

  • Antibiotic prophylaxis to avoid infections, especially for low-protein ascites fluid or history of prior SBP

  • Check body weight daily; contact provider for rapid weight gain (eg, >5 lb in 2 days)

Hepatic encephalopathy
  • Treat triggering event (eg, infection, GI bleeding, kidney dysfunction)

  • Prevent recurrence by reducing toxins; treat with lactulose and/or rifaximin

  • Avoid dehydration

  • Monitor for changes in personality/behavior

  • Treatment adherence

Esophageal varices/GI bleeding treated with beta blockers
  • Eliminate beta blockers, if feasible

  • Monitor for symptoms of recurrence

Diabetes
  • Terminate oral hypoglycemic treatment and begin an insulin regimen

  • Advise dietary changes to optimize blood sugar control (diabetic diet)

  • Dietary adherence, sugar control

Malnutrition and/or debility
  • Advise a high-protein diet

  • Considerations for other dietary changes, such as diabetic diet, low sodium/fluid restriction (if ascites and/or hyponatremia), renal diet

  • Nutrition consultation plus physical or occupational therapy to increase strength and reduce sarcopenia/malnutrition

  • Attend nutritional consultation and regular follow-ups

Hyponatremia
  • Monitor for hyponatremia

  • Monitor for decline in kidney function/end-stage renal disease; initiate RRT

  • Advise dietary changes, ie, fluid restriction or renal diet if applicable

  • Attend nutritional consultation if advised

  • Dietary adherence; fluid restriction

  • Monitor urination; report reduced frequency

Hypotension
  • Ongoing vigilance

  • Modify treatment regimen as needed (ie, initiate midodrine in improve renal blood flow and pressure)

  • Rigorous tracking of blood pressure and heart rate

  • Medication adherence

  • Prompt reporting of changes to clinical team

Polypharmacy
  • Monitor prescriptions/treatments

  • Vigilance for potential drug-drug or drug-food interactions

  • Medication adherence

  • Reporting of side effects

Overall patient care
  • Nurse navigator/coordinator to advise patient and/or clinical team regarding changes in health status or treatments, especially starting/stopping medications

  • Patient/caregiver education on ways to prevent renal injury (ie, avoidance of certain medications, monitoring of weight fluctuations, noting if increase or decrease in urine output, minimize risk for dehydration or risk for infections)

  • Engagement with treatment team

  • Adherence to treatment regimen(s)

Abbreviations: GI, gastrointestinal; HRS-AKI, hepatorenal syndrome type of acute kidney injury; RRT, renal replacement therapy; SBP, spontaneous bacterial peritonitis.