ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2025
Acute Kidney Injury in Patients With Cirrhosis and Chronic Kidney Disease: Results From the HRS-HARMONY Consortium.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Predictors of In-Hospital Mortality and Incomplete Kidney Recovery in Patients with Cirrhosis-Associated Non-Hepatorenal Syndrome Acute Kidney Injury: A Single-Center Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- Evaluation of Kidney Function in Cirrhosis: Methods and Pitfalls.Diagnostics (Basel, Switzerland) · 2026Review
- United States Experience With Terlipressin in Hepatorenal Syndrome: Response, Mortality, and Transplant Outcomes - Results From the HRS Harmony Consortium.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026Article
- Bridging Critically Ill Patients With Cirrhosis to Transplant With Renal Replacement Therapy: A Multicenter Cohort Study.Liver international : official journal of the International Association for the Study of the Liver · 2026Observational
- Expanding the boundaries of kidney replacement therapy in patients with liver failure.World journal of critical care medicine · 2025Review
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21 authors.
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Abstract
BACKGROUND &
aimsChronic kidney disease (CKD) frequency is increasing in patients with cirrhosis and these individuals often experience acute kidney injury (AKI). Direct comparisons of outcomes between AKI-only versus AKI on CKD (AoCKD) among patients with cirrhosis are not well described.
methodsA total of 2057 patients with cirrhosis and AKI across 11 hospital networks from the HRS-HARMONY consortium were analyzed (70% AKI-only and 30% AoCKD). The primary outcome was unadjusted and adjusted 90-day mortality, with transplant as a competing risk, using Fine and Gray analysis.
resultsCompared with patients with AKI-only, patients with AoCKD had higher median admission creatinine (2.25 [interquartile range, 1.7-3.2] vs 1.83 [1.38-2.58] mg/dL) and peak creatinine (2.79 [2.12-4] vs 2.42 [1.85-3.50] mg/dL) but better liver function parameters (total bilirubin 1.5 [interquartile range, 0.7-3.1] vs 3.4 [1.5-9.3] mg/dL; and international normalized ratio 1.4 [interquartile range, 1.2-1.8] vs 1.7 [1.39-2.2]; P < .001 for all). Patients with AoCKD were more likely to have metabolic dysfunction associated steatotic liver disease cirrhosis (31% vs 17%) and less likely to have alcohol-associated liver disease (26% vs 45%; P < .001 for both). Patients with AKI-only had higher unadjusted mortality (39% vs 30%), rate of intensive care unit admission (52% vs 35%; P < .001 for both), and use of renal-replacement therapy (20% vs 15%; P = .005). After adjusting for age, race, sex, transplant listing status, and Model for End-Stage Liver Disease-Sodium score, AoCKD was associated with a lower 90-day mortality compared with AKI-only (subhazard ratio, 0.72; 95% confidence interval, 0.61-0.87).
conclusionsIn hospitalized patients with AKI and cirrhosis, AoCKD was associated with lower 90-day mortality compared with AKI-only. This may be caused by the impact of worse liver function parameters in the AKI-only group on short-term outcomes. Further study of the complicated interplay between acute and chronic kidney disease in cirrhosis is needed.
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