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Acute kidney injury in patients with cirrhosis of liver: Clinical profile and predictors of outcome

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Abstract

Background

Acute kidney injury (AKI) is a common complication of liver cirrhosis and is associated with poor survival. We studied the clinical profile and predictors of in-hospital mortality in patients with cirrhosis of the liver with AKI.

Methods

This retrospective cohort study examined patients at a tertiary care hospital. AKI staging was done based on the new 2015 Ascites Club Criteria. Patients were grouped into three types of AKI: pre-renal azotemia (PRA), hepatorenal syndrome (HRS), and acute tubular necrosis (ATN).

Results

Data of 123 patients with cirrhosis and AKI were analyzed. Most patients had AKI stage 3 (57.7%). ATN (42.3%) and HRS (43.9) were the predominant types of AKI followed by PRA (13.8%). The overall in-hospital mortality in our study was 44.7%. The mortality increased with increasing severity of AKI (p = 0.0001) and was the highest in AKI stage 3 (p = 0.001) and those who required hemodialysis (p = 0.001). There was a significant in-hospital mortality in patients with ATN and HRS in comparison to PRA (p = 0.001). On multivariate analysis, the factors predicting in-hospital mortality were AKI stage 3, and oliguria (p = 0.0001).

Conclusions

Acute kidney injury in cirrhosis of liver carries high in-hospital mortality. Pre-renal AKI has a better survival compared to ATN and HRS. The higher stage of AKI at presentation and the presence of oliguria are two important predictors of in-hospital mortality.

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Acknowledgements

The authors acknowledged the Manipal Academy of Higher Education.

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Authors and Affiliations

  1. Department of Gastroenterology, Kasturba Medical College, Manipal Academy of Higher Education, Tiger Circle Road, Madhav Nagar, Manipal, 576 104, India

    Shiran Shetty

  2. Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Tiger Circle Road, Madhav Nagar, Manipal, 576 104, India

    Shankar Prasad Nagaraju, Srinivas Shenoy, Ravindra Prabhu Attur, Dharshan Rangaswamy & Indu R. Rao

  3. Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Deralakatte, Mangaluru, 575 018, India

    Uday Venkat Mateti

  4. Department of Nephrology, Madras Medical Mission, 4A, Dr J J Nagar, Mogappair, Chennai, 600 037, India

    Rajeevalochana Parthasarathy

Authors
  1. Shiran Shetty
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  2. Shankar Prasad Nagaraju
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  3. Srinivas Shenoy
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  4. Ravindra Prabhu Attur
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  5. Dharshan Rangaswamy
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  6. Indu R. Rao
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  7. Uday Venkat Mateti
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  8. Rajeevalochana Parthasarathy
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Corresponding author

Correspondence to Shankar Prasad Nagaraju.

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Conflict of interest

SS, SPN, SS, RPA, DR, IRN, UVM, and RP declare that they have no conflict of interest.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

The study protocol was approved by the institutional review board and ethics committee.

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Shetty, S., Nagaraju, S.P., Shenoy, S. et al. Acute kidney injury in patients with cirrhosis of liver: Clinical profile and predictors of outcome. Indian J Gastroenterol 37, 248–254 (2018). https://doi.org/10.1007/s12664-018-0867-4

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  • DOI: https://doi.org/10.1007/s12664-018-0867-4

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