A cute kidney injury (AKI) is common and can be deadly in patients with cirrhosis. There are a variety of causes of AKI in the patient population with cirrhosis. As nephrologists, we are often asked to consult on such cases to rule out hepatorenal syndrome (HRS). But how common is HRS?
A recent study published by Patidar et al. (1) in the Journal of Hepatology sheds light on the true incidence of this phenomenon. This was a retrospective cohort study of 11 hospital networks of consecutive adult patients admitted in 2019 with AKI and cirrhosis, totaling over 2000 patients (median age, 62 years; 38.3% female; median model for end stage liver disease-serum sodium [MELD-Na] score, 26). The etiology of AKI was adjudicated based on pre-specified clinical definitions (prerenal/hypovolemic AKI, HRS-AKI, acute tubular necrosis [ATN], and others). The study showed that hypovolemic or prerenal AKI was the most common (44%), followed by ATN (30%), and then HRS (12%). Patients with prerenal AKI had the lowest rate of death. ATN and HRS had similar outcomes (~50% mortality at 90 days).
Another study published recently by Singal et al. (2) of 2016–2019 National Inpatient Sample admissions demonstrated similar incidence of HRS as the study by Patidar et al. (1) (16.5% of admissions for AKI and cirrhosis using billing codes versus 12.1% fully adjudicated cases). They also found nearly identical outcomes in hospital mortality rates (24.5% versus 25.8%). Both studies lacked kidney biopsy data. These studies may guide us in recognizing that HRS is uncommon and that ATN may be more important to consider, as it has similar outcomes as HRS-AKI.
Content covered in this issue of Kidney News further highlights the liver and kidney connection. With a focus on kidney diseases in liver transplantation, we present the complexities of simultaneous liver and kidney versus liver-alone transplantation and explore prognostic biomarkers of posttransplant complications. We also review various glomerular diseases seen with hepatitis B and C, examine the role of palliative care in combined kidney and liver diseases, and discuss the impact of hyperbilirubinemia on kidney function, among other topics. We hope the readers find this special issue helpful in their care for their patients with both liver and kidney diseases.
References
- 1.↑
Patidar KR, et al.; from the HRS-HARMONY consortium. Incidence and outcomes of acute kidney injury including hepatorenal syndrome in hospitalized patients with cirrhosis in the US. J Hepatol (published online ahead of print July 28, 2023). doi: 10.1016/j.jhep.2023.07.010; https://www.journal-of-hepatology.eu/article/S0168-8278(23)04990-5/fulltext
- 2.↑
Singal AK, et al. Healthcare burden and outcomes of hepatorenal syndrome among cirrhosis-related hospitalisations in the US. Aliment Pharmacol Ther 2022; 56:1486–1496. doi: 10.1111/apt.17232
