Evidence map›Paper›PMID 39215868›Full record

ArticleDigestive diseases and sciences2024

Prognosis of Transplant-Ineligible Patients with Cirrhosis and Acute Kidney Injury Who Initiate Renal Replacement Therapy.

Paige McLean Diaz, Danielle L Saly, Nora Horick, Romela Petrosyan, Zachary Gitto, Teresa Indriolo, Lucinda Li, Olivia Kahn-Boesel, John Donlan, Blair Robinson and 9 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Digestive diseases and sciences, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
  4. Treating Hepatorenal Syndrome in the Current Era.Journal of the American Society of Nephrology : JASN · 2026
    Review
  5. Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Paige McLean DiazDepartment of Gastroenterology, Hepatology & Nutrition, Center for Liver Disease, University of Chicago Medicine, Chicago, IL, USA.
Danielle L SalyDivision of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Nora HorickMGH Biostatistics, Massachusetts General Hospital, Boston, MA, USA.
Romela PetrosyanDivision of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Zachary GittoDivision of Gastroenterology and Hepatology, University of South Carolina School of Medicine, Columbia, SC, USA.
Teresa IndrioloGastrointestinal Unit, Gastrointestinal Division, Department of Medicine, Liver Center, Massachusetts General Hospital, Boston, MA, USA.
Lucinda LiGastrointestinal Unit, Gastrointestinal Division, Department of Medicine, Liver Center, Massachusetts General Hospital, Boston, MA, USA.
Olivia Kahn-BoeselDepartment of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
John DonlanDepartment of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
Blair RobinsonDivision of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Lindsay DowDivision of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Annie LiuDivision of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Areej El-JawahriDivision of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA.
Xavier Vela ParadaDivision of Nephrology, UMass Memorial Medical Center, Worcester, MA, USA.
Sara CombsDivisions of Nephrology and Palliative Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Joao TeixeiraDivisions of Nephrology and Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Raymond ChungGastrointestinal Unit, Gastrointestinal Division, Department of Medicine, Liver Center, Massachusetts General Hospital, Boston, MA, USA.
Andrew S AllegrettiDivision of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Nneka N UfereGastrointestinal Unit, Gastrointestinal Division, Department of Medicine, Liver Center, Massachusetts General Hospital, Boston, MA, USA. nneka.ufere@mgh.harvard.edu.

Funding

Personalizing Therapies for Acute Kidney Injury in CirrhosisK23DK128567 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI Andrew S Allegretti · 2022 to 2026
$982k
American Association for the Study of Liver Diseases Clinical, Translational, and Outcomes Research AwardCambia Health Foundation,United States Sojourns Scholar AwardMassachusetts General Hospital Physician Scientist Development AwardNIDDK NIH HHS DK128567NIDDK NIH HHS K23 DK128567
6 · The paper itself

Abstract

backgroundData to guide dialysis decision-making for transplant-ineligible patients with cirrhosis are lacking.

aimsWe aimed to describe the processes, predictors, and outcomes of renal replacement therapy (RRT) initiation for transplant-ineligible patients with cirrhosis at a single liver transplantation center.

methodsWe conducted a mixed-methods study of a retrospective cohort of 372 transplant-ineligible inpatients with cirrhosis with acute kidney injury (AKI) due to hepatorenal syndrome (HRS-AKI) or acute tubular necrosis (ATN) between 2008 and 2015. We performed survival analyses to evaluate 6-month survival and renal recovery and examined end-of-life care outcomes. We used a consensus-driven medical record review to characterize processes leading to RRT initiation.

resultsWe identified 266 (71.5%) patients who received RRT and 106 (28.5%) who did not receive RRT (non-RRT). Median survival was 12.5 days (RRT) vs. 2.0 days (non-RRT) (HR 0.36, 95%CI 0.28-0.46); 6-month survival was 15% (RRT) vs. 0% (non-RRT). RRT patients were more likely to die in the intensive care unit (88% vs. 32%, p < 0.001). HRS-AKI patients were more likely to be RRT dependent at 6 months than ATN patients (86% vs. 27%, p = 0.007). The most common reasons for RRT initiation were unclear etiology of AKI on presentation (32%) and belief of likely reversibility of ATN (82%).

conclusionMost transplant-ineligible patients who were initiated on RRT experienced very short-term mortality and received intensive end-of-life care. However, approximately 1 in 6 were alive at 6 months. Our findings underscore the critical need for structured clinical processes to support high-quality serious illness communication and RRT decision-making for this population.

Indexed as

Acute Kidney InjuryLiver CirrhosisRenal Replacement TherapyAgedFemaleHepatorenal SyndromeHumansLiver TransplantationMaleMiddle AgedPrognosisRetrospective StudiesAcute on chronic liver failureDialysisEnd-stage liver diseasePalliative carePalliative hepatology

Identifiers

PMID39215868
PMCPMC11647743

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.