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AKI in patients with acute on chronic liver failure is different from acute decompensation of cirrhosis
Background and aims The current definitions of acute kidney injury (AKI) including HRS have been derived from patients with decompensated cirrhosis. No studies have carefully addressed AKI in patients with acute on chronic liver failure (ACLF). We evaluated the prevalence, spectrum, natural history...
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| Published in: | Hepatology international 2015-10, Vol.9 (4), p.627-639 |
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| creator | Maiwall, Rakhi Kumar, Suman Chandel, Shivendra Singh Kumar, Guresh Rastogi, Archana Bihari, Chhagan Sharma, Manoj Kumar Thakur, Bhaskar Jamwal, K. Nayak, Suman Mathur, R. P. Sarin, S. K. |
| description | Background and aims
The current definitions of acute kidney injury (AKI) including HRS have been derived from patients with decompensated cirrhosis. No studies have carefully addressed AKI in patients with acute on chronic liver failure (ACLF). We evaluated the prevalence, spectrum, natural history and mortality of AKI at admission and new-onset AKI in hospitalized patients with ACLF and compared the results with patients with acute decompensation of cirrhosis (ADC).
Patients and methods
Consecutive patients with ACLF (
n
= 382) and ADC (
n
= 451) were prospectively studied. Serial renal and liver functions were recorded and correlated with the disease course and outcome.
Results
AKI at admission and new onset AKI in the hospital were not different in patients with ACLF and ADC (
p
> 0.05). However, a significant difference in the spectrum of AKI was noted; functional volume-responsive AKI was more common (
p
|
| doi_str_mv | 10.1007/s12072-015-9653-x |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1724258946</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1724258946</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-a102b3333a2031aca233ea3363eb5d4e6c21db9b4f0d1de06337d73b17c18fbb3</originalsourceid><addsrcrecordid>eNp1kc1KxDAURoMoOo4-gBsJuHFTzU3a1C5F_EPBja5Dmt44kbYZk1bHtzfDjIMIZpNAzvluyEfIEbAzYKw8j8BZyTMGRVbJQmSLLTKBSsiMFTlsb85C7JH9GN8YKwoJcpfscSl4BRwm5PXy4Z66ns714LAfIv10w4xqMw5IfU_NLPjeGdq6DwzUateOAamLtHHWYkgGtcF3a6FB47s59jGFJdlbalwIMx9dPCA7VrcRD9f7lLzcXD9f3WWPT7f3V5ePmclzPmQaGK9FWpozAdpoLgRqIaTAumhylIZDU1d1blkDDTIpRNmUoobSwIWtazElp6vcefDvI8ZBdS4abFvdox-jgpLnvLiocpnQkz_omx9Dn163pLisJKsgUbCiTPAxBrRqHlynw5cCppYtqFULKrWgli2oRXKO18lj3WGzMX6-PQF8BcR01b9i-DX639RvI5qTBQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1722696091</pqid></control><display><type>article</type><title>AKI in patients with acute on chronic liver failure is different from acute decompensation of cirrhosis</title><source>Springer Nature</source><creator>Maiwall, Rakhi ; Kumar, Suman ; Chandel, Shivendra Singh ; Kumar, Guresh ; Rastogi, Archana ; Bihari, Chhagan ; Sharma, Manoj Kumar ; Thakur, Bhaskar ; Jamwal, K. ; Nayak, Suman ; Mathur, R. P. ; Sarin, S. K.</creator><creatorcontrib>Maiwall, Rakhi ; Kumar, Suman ; Chandel, Shivendra Singh ; Kumar, Guresh ; Rastogi, Archana ; Bihari, Chhagan ; Sharma, Manoj Kumar ; Thakur, Bhaskar ; Jamwal, K. ; Nayak, Suman ; Mathur, R. P. ; Sarin, S. K.</creatorcontrib><description><![CDATA[Background and aims
The current definitions of acute kidney injury (AKI) including HRS have been derived from patients with decompensated cirrhosis. No studies have carefully addressed AKI in patients with acute on chronic liver failure (ACLF). We evaluated the prevalence, spectrum, natural history and mortality of AKI at admission and new-onset AKI in hospitalized patients with ACLF and compared the results with patients with acute decompensation of cirrhosis (ADC).
Patients and methods
Consecutive patients with ACLF (
n
= 382) and ADC (
n
= 451) were prospectively studied. Serial renal and liver functions were recorded and correlated with the disease course and outcome.
Results
AKI at admission and new onset AKI in the hospital were not different in patients with ACLF and ADC (
p
> 0.05). However, a significant difference in the spectrum of AKI was noted; functional volume-responsive AKI was more common (
p
< 0.05) in ADC, while patients with ACLF more frequently had the structural form of AKI (
p
< 0.05). Moreover, patients with ADC had significantly less AKI progression (
p
< 0.05) and prolonged duration (
p
< 0.05), a lower requirement of RRT (
p
< 0.05) and also less AKI resolution (
p
< 0.05) compared to ACLF patients. Patients with ACLF (versus ADC) had a significantly higher mortality on multivariate analysis.
Conclusions
The kidneys are differentially affected in patients with cirrhosis with or without liver failure. Patients with ACLF with AKI have more structural AKI, greater potential for reversibility despite higher progression as well as higher mortality compared to patients with ADC. Prevention and early detection of AKI should be considered in patients with ACLF.]]></description><identifier>ISSN: 1936-0533</identifier><identifier>EISSN: 1936-0541</identifier><identifier>DOI: 10.1007/s12072-015-9653-x</identifier><identifier>PMID: 26329121</identifier><language>eng</language><publisher>New Delhi: Springer India</publisher><subject>Acute Kidney Injury - diagnosis ; Acute Kidney Injury - epidemiology ; Acute Kidney Injury - etiology ; Acute-On-Chronic Liver Failure - complications ; Acute-On-Chronic Liver Failure - diagnosis ; Adult ; Biopsy ; Colorectal Surgery ; Disease Progression ; Early Diagnosis ; Female ; Follow-Up Studies ; Hepatology ; Humans ; Incidence ; India - epidemiology ; Kidney - pathology ; Liver - diagnostic imaging ; Liver - pathology ; Liver Cirrhosis - complications ; Liver Cirrhosis - diagnosis ; Magnetic Resonance Imaging ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Prognosis ; Prospective Studies ; Surgery ; Tomography, X-Ray Computed ; Ultrasonography</subject><ispartof>Hepatology international, 2015-10, Vol.9 (4), p.627-639</ispartof><rights>Asian Pacific Association for the Study of the Liver 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-a102b3333a2031aca233ea3363eb5d4e6c21db9b4f0d1de06337d73b17c18fbb3</citedby><cites>FETCH-LOGICAL-c442t-a102b3333a2031aca233ea3363eb5d4e6c21db9b4f0d1de06337d73b17c18fbb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26329121$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Maiwall, Rakhi</creatorcontrib><creatorcontrib>Kumar, Suman</creatorcontrib><creatorcontrib>Chandel, Shivendra Singh</creatorcontrib><creatorcontrib>Kumar, Guresh</creatorcontrib><creatorcontrib>Rastogi, Archana</creatorcontrib><creatorcontrib>Bihari, Chhagan</creatorcontrib><creatorcontrib>Sharma, Manoj Kumar</creatorcontrib><creatorcontrib>Thakur, Bhaskar</creatorcontrib><creatorcontrib>Jamwal, K.</creatorcontrib><creatorcontrib>Nayak, Suman</creatorcontrib><creatorcontrib>Mathur, R. P.</creatorcontrib><creatorcontrib>Sarin, S. K.</creatorcontrib><title>AKI in patients with acute on chronic liver failure is different from acute decompensation of cirrhosis</title><title>Hepatology international</title><addtitle>Hepatol Int</addtitle><addtitle>Hepatol Int</addtitle><description><![CDATA[Background and aims
The current definitions of acute kidney injury (AKI) including HRS have been derived from patients with decompensated cirrhosis. No studies have carefully addressed AKI in patients with acute on chronic liver failure (ACLF). We evaluated the prevalence, spectrum, natural history and mortality of AKI at admission and new-onset AKI in hospitalized patients with ACLF and compared the results with patients with acute decompensation of cirrhosis (ADC).
Patients and methods
Consecutive patients with ACLF (
n
= 382) and ADC (
n
= 451) were prospectively studied. Serial renal and liver functions were recorded and correlated with the disease course and outcome.
Results
AKI at admission and new onset AKI in the hospital were not different in patients with ACLF and ADC (
p
> 0.05). However, a significant difference in the spectrum of AKI was noted; functional volume-responsive AKI was more common (
p
< 0.05) in ADC, while patients with ACLF more frequently had the structural form of AKI (
p
< 0.05). Moreover, patients with ADC had significantly less AKI progression (
p
< 0.05) and prolonged duration (
p
< 0.05), a lower requirement of RRT (
p
< 0.05) and also less AKI resolution (
p
< 0.05) compared to ACLF patients. Patients with ACLF (versus ADC) had a significantly higher mortality on multivariate analysis.
Conclusions
The kidneys are differentially affected in patients with cirrhosis with or without liver failure. Patients with ACLF with AKI have more structural AKI, greater potential for reversibility despite higher progression as well as higher mortality compared to patients with ADC. Prevention and early detection of AKI should be considered in patients with ACLF.]]></description><subject>Acute Kidney Injury - diagnosis</subject><subject>Acute Kidney Injury - epidemiology</subject><subject>Acute Kidney Injury - etiology</subject><subject>Acute-On-Chronic Liver Failure - complications</subject><subject>Acute-On-Chronic Liver Failure - diagnosis</subject><subject>Adult</subject><subject>Biopsy</subject><subject>Colorectal Surgery</subject><subject>Disease Progression</subject><subject>Early Diagnosis</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Incidence</subject><subject>India - epidemiology</subject><subject>Kidney - pathology</subject><subject>Liver - diagnostic imaging</subject><subject>Liver - pathology</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Surgery</subject><subject>Tomography, X-Ray Computed</subject><subject>Ultrasonography</subject><issn>1936-0533</issn><issn>1936-0541</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNp1kc1KxDAURoMoOo4-gBsJuHFTzU3a1C5F_EPBja5Dmt44kbYZk1bHtzfDjIMIZpNAzvluyEfIEbAzYKw8j8BZyTMGRVbJQmSLLTKBSsiMFTlsb85C7JH9GN8YKwoJcpfscSl4BRwm5PXy4Z66ns714LAfIv10w4xqMw5IfU_NLPjeGdq6DwzUateOAamLtHHWYkgGtcF3a6FB47s59jGFJdlbalwIMx9dPCA7VrcRD9f7lLzcXD9f3WWPT7f3V5ePmclzPmQaGK9FWpozAdpoLgRqIaTAumhylIZDU1d1blkDDTIpRNmUoobSwIWtazElp6vcefDvI8ZBdS4abFvdox-jgpLnvLiocpnQkz_omx9Dn163pLisJKsgUbCiTPAxBrRqHlynw5cCppYtqFULKrWgli2oRXKO18lj3WGzMX6-PQF8BcR01b9i-DX639RvI5qTBQ</recordid><startdate>20151001</startdate><enddate>20151001</enddate><creator>Maiwall, Rakhi</creator><creator>Kumar, Suman</creator><creator>Chandel, Shivendra Singh</creator><creator>Kumar, Guresh</creator><creator>Rastogi, Archana</creator><creator>Bihari, Chhagan</creator><creator>Sharma, Manoj Kumar</creator><creator>Thakur, Bhaskar</creator><creator>Jamwal, K.</creator><creator>Nayak, Suman</creator><creator>Mathur, R. P.</creator><creator>Sarin, S. K.</creator><general>Springer India</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20151001</creationdate><title>AKI in patients with acute on chronic liver failure is different from acute decompensation of cirrhosis</title><author>Maiwall, Rakhi ; Kumar, Suman ; Chandel, Shivendra Singh ; Kumar, Guresh ; Rastogi, Archana ; Bihari, Chhagan ; Sharma, Manoj Kumar ; Thakur, Bhaskar ; Jamwal, K. ; Nayak, Suman ; Mathur, R. P. ; Sarin, S. K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-a102b3333a2031aca233ea3363eb5d4e6c21db9b4f0d1de06337d73b17c18fbb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Acute Kidney Injury - diagnosis</topic><topic>Acute Kidney Injury - epidemiology</topic><topic>Acute Kidney Injury - etiology</topic><topic>Acute-On-Chronic Liver Failure - complications</topic><topic>Acute-On-Chronic Liver Failure - diagnosis</topic><topic>Adult</topic><topic>Biopsy</topic><topic>Colorectal Surgery</topic><topic>Disease Progression</topic><topic>Early Diagnosis</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Incidence</topic><topic>India - epidemiology</topic><topic>Kidney - pathology</topic><topic>Liver - diagnostic imaging</topic><topic>Liver - pathology</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Surgery</topic><topic>Tomography, X-Ray Computed</topic><topic>Ultrasonography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maiwall, Rakhi</creatorcontrib><creatorcontrib>Kumar, Suman</creatorcontrib><creatorcontrib>Chandel, Shivendra Singh</creatorcontrib><creatorcontrib>Kumar, Guresh</creatorcontrib><creatorcontrib>Rastogi, Archana</creatorcontrib><creatorcontrib>Bihari, Chhagan</creatorcontrib><creatorcontrib>Sharma, Manoj Kumar</creatorcontrib><creatorcontrib>Thakur, Bhaskar</creatorcontrib><creatorcontrib>Jamwal, K.</creatorcontrib><creatorcontrib>Nayak, Suman</creatorcontrib><creatorcontrib>Mathur, R. P.</creatorcontrib><creatorcontrib>Sarin, S. K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Hepatology international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maiwall, Rakhi</au><au>Kumar, Suman</au><au>Chandel, Shivendra Singh</au><au>Kumar, Guresh</au><au>Rastogi, Archana</au><au>Bihari, Chhagan</au><au>Sharma, Manoj Kumar</au><au>Thakur, Bhaskar</au><au>Jamwal, K.</au><au>Nayak, Suman</au><au>Mathur, R. P.</au><au>Sarin, S. K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>AKI in patients with acute on chronic liver failure is different from acute decompensation of cirrhosis</atitle><jtitle>Hepatology international</jtitle><stitle>Hepatol Int</stitle><addtitle>Hepatol Int</addtitle><date>2015-10-01</date><risdate>2015</risdate><volume>9</volume><issue>4</issue><spage>627</spage><epage>639</epage><pages>627-639</pages><issn>1936-0533</issn><eissn>1936-0541</eissn><abstract><![CDATA[Background and aims
The current definitions of acute kidney injury (AKI) including HRS have been derived from patients with decompensated cirrhosis. No studies have carefully addressed AKI in patients with acute on chronic liver failure (ACLF). We evaluated the prevalence, spectrum, natural history and mortality of AKI at admission and new-onset AKI in hospitalized patients with ACLF and compared the results with patients with acute decompensation of cirrhosis (ADC).
Patients and methods
Consecutive patients with ACLF (
n
= 382) and ADC (
n
= 451) were prospectively studied. Serial renal and liver functions were recorded and correlated with the disease course and outcome.
Results
AKI at admission and new onset AKI in the hospital were not different in patients with ACLF and ADC (
p
> 0.05). However, a significant difference in the spectrum of AKI was noted; functional volume-responsive AKI was more common (
p
< 0.05) in ADC, while patients with ACLF more frequently had the structural form of AKI (
p
< 0.05). Moreover, patients with ADC had significantly less AKI progression (
p
< 0.05) and prolonged duration (
p
< 0.05), a lower requirement of RRT (
p
< 0.05) and also less AKI resolution (
p
< 0.05) compared to ACLF patients. Patients with ACLF (versus ADC) had a significantly higher mortality on multivariate analysis.
Conclusions
The kidneys are differentially affected in patients with cirrhosis with or without liver failure. Patients with ACLF with AKI have more structural AKI, greater potential for reversibility despite higher progression as well as higher mortality compared to patients with ADC. Prevention and early detection of AKI should be considered in patients with ACLF.]]></abstract><cop>New Delhi</cop><pub>Springer India</pub><pmid>26329121</pmid><doi>10.1007/s12072-015-9653-x</doi><tpages>13</tpages></addata></record> |
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| ispartof | Hepatology international, 2015-10, Vol.9 (4), p.627-639 |
| issn | 1936-0533 1936-0541 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1724258946 |
| source | Springer Nature |
| subjects | Acute Kidney Injury - diagnosis Acute Kidney Injury - epidemiology Acute Kidney Injury - etiology Acute-On-Chronic Liver Failure - complications Acute-On-Chronic Liver Failure - diagnosis Adult Biopsy Colorectal Surgery Disease Progression Early Diagnosis Female Follow-Up Studies Hepatology Humans Incidence India - epidemiology Kidney - pathology Liver - diagnostic imaging Liver - pathology Liver Cirrhosis - complications Liver Cirrhosis - diagnosis Magnetic Resonance Imaging Male Medicine Medicine & Public Health Middle Aged Original Article Prognosis Prospective Studies Surgery Tomography, X-Ray Computed Ultrasonography |
| title | AKI in patients with acute on chronic liver failure is different from acute decompensation of cirrhosis |
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