Chances of Renal Recovery or Liver Transplantation After Hospitalization for Alcoholic Liver Disease Requiring Dialysis
Acute kidney injury in the setting of alcoholic liver disease portends a poor prognosis without liver transplant.
Using a tertiary care population, we aimed to evaluate the outcomes of renal replacement therapy in patients with alcoholic liver disease and acute kidney injury with < 6 months sobriety.
A retrospective review of hospitalized patients with alcoholic hepatitis/acute on chronic alcoholic cirrhosis and hepatorenal syndrome or acute tubular necrosis was performed. Analyzed variables included patient comorbidities, mode of dialysis, MELD-Na score, CLIF-C ACLF score, and CLIF-C OF score.
Forty-seven patients were included, 21.3% of which survived 6 months of sobriety to be eligible for transplant evaluation. Despite renal replacement therapy, mortality was 78.7%. Of survivors, 4 received transplants and 6 recovered without transplant. Lower CLIF-C ACLF (p < 0.001) and CLIF-C OF (p = 0.001) predicted 6-month survival and lower MELD-Na (p = 0.016), CLIF-C ACLF (p < 0.001), and CLIF-C OF (p = 0.006) predicted renal recovery. There was no difference in survival or renal recovery between etiologies of kidney injury. Modality of initial dialysis with intermittent hemodialysis compared to continuous renal replacement therapy predicted improved survival (41.2 vs. 10.0%, p = 0.01) and nearly reached significance for renal recovery (23.5 vs. 6.7%, p = 0.054).
Although severe alcoholic liver disease with acute kidney injury is associated with a high mortality irrespective of the etiology of renal failure, over 20% of patients in this study survived 6 months to be evaluated for liver transplant and 12.8% recovered renal function. These outcomes should be considered when weighing the decision of initiating dialysis.
KeywordsAlcohol-related liver disease Liver transplantation Cirrhosis Acute kidney injury Renal replacement therapy
Acute kidney injury
Alcoholic liver disease
Maddrey discriminant function
Model for end-stage liver disease
Compliance with ethical standards
Conflict of interest
No conflicts of interest and no writing assistance were utilized.