| Abstract: | BACKGROUND & AIMS: Acute kidney disease (AKD) is the persistence of acute kidney injury (AKI) up to 3 months and is proposed to be the time-window where critical interventions can be initiated to alter downstream outcomes of AKI. In cirrhosis, AKD and its impact on outcomes have been sparsely investigated. We aimed to define the incidence and outcomes associated with AKD in a nationwide US-cohort of hospitalized patients with cirrhosis and AKI. METHODS: Hospitalized patients with cirrhosis and AKI in the Cerner-Health-Facts database from 1/2009-09/2017 (n=6,250) were assessed for AKD and were followed for 180 days for outcomes. AKI and AKD were defined based on Kidney-Disease-Improving-Global-Outcomes (KDIGO) and Acute-Disease-Quality-Initiative-AKD and Renal-Recovery consensus criteria respectively. Primary outcome was mortality; secondary outcome was de-novo chronic kidney disease (CKD). Competing-risk multivariable models were used to determine the independent association of AKD for primary and secondary outcomes. RESULTS: AKD developed in 32%. On multivariable competing risk analysis adjusting for significant confounders, patients with AKD had higher risk for mortality at 90 [sHR 1.37 (95%CI 1.14-1.66), p=0.001) and 180-days [sHR 1.37 (95%CI 1.14-1.64), p=0.001]. The incidence of de-novo-CKD was 37.5% and patients with AKD had higher rates of de-novo-CKD at 64.0% compared to patients without AKD at 30.7% (p<0.001). After adjusting for confounders, AKD was independently associated with de-novo-CKD [sHR 2.52 (95%CI 2.01-3.15), p<0.001] on multivariable competing-risk analysis. CONCLUSIONS: AKD develops in 1 in 3 hospitalized patients with cirrhosis and AKI and it is associated with worse survival and de-novo-CKD. Interventions that target AKD may improve outcomes of patients with cirrhosis and AKI. LAY SUMMARY: In a nationwide US cohort of hospitalized patients with cirrhosis and acute kidney injury (AKI), acute kidney disease (AKD) develops in 1 in 3 patients and is associated with worse survival and chronic kidney disease. Interventions that target AKD may improve outcomes of patients with cirrhosis and AKI. |
