Longer Time to Recovery From Acute Kidney Injury Is Associated With Major Adverse Kidney Events in Patients With Cirrhosis

Authors

Kavish R Patidar
Mobasshir A Naved
Shaowli Kabir
Ananth Grama
Andrew S Allegretti
Giuseppe Cullaro
Sumeet K Asrani
Astin Worden
Archita P Desai
Marwan S Ghabril
Lauren D Nephew
Eric S Orman

Publication Date

6-1-2023

Journal

Alimentary Pharmacology & Therapeutics

DOI

10.1111/apt.17457

PMID

36883210

PMCID

PMC10441172

PubMedCentral® Posted Date

8-21-2023

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Risk Factors, Disease Progression, Retrospective Studies, Kidney, Acute Kidney Injury, Renal Insufficiency, Chronic, Liver Cirrhosis, Glomerular Filtration Rate

Abstract

BACKGROUND: In patients with cirrhosis and acute kidney injury (AKI), longer time to AKI-recovery may increase the risk of subsequent major-adverse-kidney-events (MAKE).

AIMS: To examine the association between timing of AKI-recovery and risk of MAKE in patients with cirrhosis.

METHODS: Hospitalised patients with cirrhosis and AKI (n = 5937) in a nationwide database were assessed for time to AKI-recovery and followed for 180-days. Timing of AKI-recovery (return of serum creatinine7-days. Primary outcome was MAKE at 90-180-days. MAKE is an accepted clinical endpoint in AKI and defined as the composite outcome of ≥25% decline in estimated-glomerular-filtration-rate (eGFR) compared with baseline with the development of de-novo chronic-kidney-disease (CKD) stage ≥3 or CKD progression (≥50% reduction in eGFR compared with baseline) or new haemodialysis or death. Landmark competing-risk multivariable analysis was performed to determine the independent association between timing of AKI-recovery and risk of MAKE.

RESULTS: 4655 (75%) achieved AKI-recovery: 0-2 (60%), 3-7 (31%), and >7-days (9%). Cumulative-incidence of MAKE was 15%, 20%, and 29% for 0-2, 3-7, >7-days recovery groups, respectively. On adjusted multivariable competing-risk analysis, compared to 0-2-days, recovery at 3-7 and >7-days was independently associated with an increased risk for MAKE: sHR 1.45 (95% CI 1.01-2.09, p = 0.042), sHR 2.33 (95% CI 1.40-3.90, p = 0.001), respectively.

CONCLUSION: Longer time to recovery is associated with an increased risk of MAKE in patients with cirrhosis and AKI. Further research should examine interventions to shorten AKI-recovery time and its impact on subsequent outcomes.