Introduction:
Acute kidney injury(AKI) incidence in liver failure is high and is associated with poor prognosis. This study assesses the spectrum of causes and outcome of AKI in acute on chronic liver disease(CLD).
Methods:
A Prospective observational study conducted in 60 patients with acute on CLD and AKI (defined by ASIAN PACIFIC ASSOCIATION FOR THE STUDY OF LIVER-ACLF RESEARCH CONSORTIUM 2019(APASL-AARC) &THE KIDNEY DISEASE OUTCOMES QUALITIVE INITIATIVE -KDIGO respectively) who were inpatients in the general and intensive medical care unit, nephrology, medical gastroenterology wards of our center, over a period of 6 months (August 2023 to January 2024). Patients with AKI in the current admission with normal creatinine in the past 3 months were included. Patients with glomerulonephritis and chronic kidney disease were excluded. The patients were followed up for 30 days from admission. The primary end point was recovery/progression of AKI or death on 30th day.
Data of complaints, clinical findings, complete blood count, renal function test, liver function test, ascitic fluid analysis were pooled and analyzed with Statistical Package for Social Sciences, SPSS Version 28.
Crystalloids, blood products, 25% albumin and noradrenaline were given based on the cause of AKI. Acute peritoneal dialysis was done based on urine output, metabolic acidosis and hyperkalemia
Results:
Mean age of the study population was 46.05 years (95% males). The CLD was related to ethanol in 71% (n=43,). Hepatitis B in 3%(n=2) . hepatitis C in1.6 %(n=1). 23% had cryptogenic cirrhosis.
The most common cause of AKI was sepsis 71%(n=43). Causes of sepsis were Urinary tract infection (16.2%, n=7), cellulitis (11.6%, n=5), pneumonia (6.9%,n=3), pancreatitis (4.6%,n=2), tropical fever (4.6%,n=2), cholangitis (4.6%, n=2), diarrhoea (2.3%, n=1), spontaneous bacterial peritonitis (2.3%,n=1,). In 46% (n= 20), cause was unidentified.
Other reasons of AKI were UGI bleed (n=7, 10%), diuretic overdose (5%, n=4), lactulose overuse (1%, n=1), vomiting (1%, n=1), hepatorenal syndrome(HRS)-AKI (1%, n=2) and nonsteroidal anti-inflammatory drug (NSAID) use (1%, n=1).
26 patients (43.3%) recovered from AKI, 7 patients (11.7%) progressed (not dialysis dependent) and 27 (45%) expired. The mean age was higher in those who died (48.18 years) compared to those who recovered (44.38 years) (p=0.045).
Of the 43 patients with sepsis, 19 recovered (44%), 19 expired (44%) and 5 (12%) had progressive AKI. Of the 7 patients with upper gastrointestinal (UGI) bleed,6 expired (86%) and in 1 patient (14%) AKI progressed. Both the patients with HRS AKI expired. 53.4% participants (n=32) had KDIGO stage 3 AKI and 46.6% (n=28) had stage 2 AKI. Mean MELDNa(model for end stage liver disease sodium) score was 38.90(SD=2.88). 33 patients had MELDNa ≥40 of which 51%(n=17) expired,12%(n=4) progressed and 36%(n=12) recovered.
17 patients (28%) were given peritoneal dialysis(rest of stage 3 AKI were not dialysed due to hemodynamic instability and logistic reasons). No significant association was found between dialysis and recovery.
Conclusions:
In this study sepsis and UGI bleed were the leading causes of AKI.UGI bleed and HRS AKI were associated with high mortality followed by sepsis. Higher mortality was observed in dialysis requiring AKI patients irrespective of MELDNa score. Early detection and treatment resulted in significant recovery.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.