Ambulatory Acute Kidney Injury in Patients With Cirrhosis Is Common and Burdensome.

IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Kavish R Patidar, Ruben Hernaez, Yan Liu, George Cholankeril, Jennifer R Kramer, Thom Taylor, Prasun Jalal, Tzu-Hao Lee, Avegail G Flores, Giuseppe Cullaro, Andrew S Allegretti, Pere Gines, Fasiha Kanwal
{"title":"Ambulatory Acute Kidney Injury in Patients With Cirrhosis Is Common and Burdensome.","authors":"Kavish R Patidar, Ruben Hernaez, Yan Liu, George Cholankeril, Jennifer R Kramer, Thom Taylor, Prasun Jalal, Tzu-Hao Lee, Avegail G Flores, Giuseppe Cullaro, Andrew S Allegretti, Pere Gines, Fasiha Kanwal","doi":"10.1016/j.cgh.2025.03.015","DOIUrl":null,"url":null,"abstract":"<p><strong>Background & aims: </strong>Little is known about ambulatory acute kidney injury (A-AKI), which develops in an outpatient setting.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients diagnosed with cirrhosis between January 1, 2018, and December 31, 2019 from 130 hospitals in the Veterans Affairs healthcare system. Patients were classified as having incident A-AKI if they met the International Club of Ascites AKI criteria in an outpatient setting. We used multivariable regression models to identify factors associated with A-AKI development within 1 year of cirrhosis diagnosis. We also conducted a structured implicit review of patients' medical charts to determine the precipitants of A-AKI. We examined the rates of AKI-resolution, hemodialysis and death at 90 days.</p><p><strong>Results: </strong>Among 55,880 patients with cirrhosis [median age 66 years, 38% alcohol-related cirrhosis (alcohol-associated liver disease), median Model for End-Stage Liver Disease-Sodium 10, 34% ascites] followed for a median of 3.4 years, 6889 (12%) patients developed incident A-AKI. Patients with ascites (odds ratio [OR], 2.51), Model for End-Stage Liver Disease-Sodium >15 (OR, 1.58), hepatocellular carcinoma (OR, 1.45) or alcohol-associated liver disease (OR, 1.37) had higher odds of developing A-AKI. In total, 60% had AKI-resolution, 4.5% progressed to hemodialysis, and 12% died within 90 days of A-AKI onset. In a review of medical records of 250 randomly selected patients with A-AKI, key precipitants were hypovolemia due to diuretics and gastrointestinal losses, and nephrotoxin medication exposure. Overall, 42% of A-AKI events were unrecognized.</p><p><strong>Conclusions: </strong>A-AKI is common in cirrhosis, associated with high 90-day mortality, and significantly under-recognized. Targeted interventions for early diagnosis and treatment could improve outcomes in high-risk patients.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6000,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Gastroenterology and Hepatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cgh.2025.03.015","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background & aims: Little is known about ambulatory acute kidney injury (A-AKI), which develops in an outpatient setting.

Methods: We conducted a retrospective cohort study of patients diagnosed with cirrhosis between January 1, 2018, and December 31, 2019 from 130 hospitals in the Veterans Affairs healthcare system. Patients were classified as having incident A-AKI if they met the International Club of Ascites AKI criteria in an outpatient setting. We used multivariable regression models to identify factors associated with A-AKI development within 1 year of cirrhosis diagnosis. We also conducted a structured implicit review of patients' medical charts to determine the precipitants of A-AKI. We examined the rates of AKI-resolution, hemodialysis and death at 90 days.

Results: Among 55,880 patients with cirrhosis [median age 66 years, 38% alcohol-related cirrhosis (alcohol-associated liver disease), median Model for End-Stage Liver Disease-Sodium 10, 34% ascites] followed for a median of 3.4 years, 6889 (12%) patients developed incident A-AKI. Patients with ascites (odds ratio [OR], 2.51), Model for End-Stage Liver Disease-Sodium >15 (OR, 1.58), hepatocellular carcinoma (OR, 1.45) or alcohol-associated liver disease (OR, 1.37) had higher odds of developing A-AKI. In total, 60% had AKI-resolution, 4.5% progressed to hemodialysis, and 12% died within 90 days of A-AKI onset. In a review of medical records of 250 randomly selected patients with A-AKI, key precipitants were hypovolemia due to diuretics and gastrointestinal losses, and nephrotoxin medication exposure. Overall, 42% of A-AKI events were unrecognized.

Conclusions: A-AKI is common in cirrhosis, associated with high 90-day mortality, and significantly under-recognized. Targeted interventions for early diagnosis and treatment could improve outcomes in high-risk patients.

肝硬化患者的动态急性肾损伤是常见和繁重的。
背景和目的对于门诊发生的急性肾损伤(AKI)知之甚少。方法:我们对退伍军人事务医疗保健系统130家医院2018年1月1日至2019年12月31日诊断为肝硬化的患者进行了回顾性队列研究。如果患者在门诊环境中符合国际腹水俱乐部AKI标准,则将其归类为突发动态AKI (A-AKI)。我们使用多变量回归模型来确定肝硬化诊断后1年内与A-AKI发展相关的因素。我们还对患者病历进行了结构化的隐性回顾,以确定a - aki的诱发因素。我们在90天内检查aki消退率、血液透析率和死亡率。结果:在55,880例肝硬化患者中[中位年龄66岁,38%酒精相关性肝硬化(ALD),中位终末期肝病模型-钠(MELD-Na) 10,34%腹水],随访中位3.4年,6,889例患者(12%)发生a - aki事件。腹水患者[比值比(OR) 2.51]、MELD-Na bbb15 (OR 1.58)、肝细胞癌(OR 1.45)或ALD (OR 1.37)发生A-AKI的几率更高。总的来说,60%的患者aki得到了缓解,4.5%的患者进行了血液透析,12%的患者在A-AKI发病后90天内死亡。在对250名随机选择的a - aki患者的医疗记录的回顾中,主要的沉淀因素是利尿剂和胃肠道功能丧失引起的低血容量,以及肾毒素药物暴露。总体而言,42%的A-AKI事件未被识别。结论:A-AKI在肝硬化中很常见,与高90天死亡率相关,且明显未被充分认识。有针对性的早期诊断和治疗干预可以改善高危患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
16.90
自引率
4.80%
发文量
903
审稿时长
22 days
期刊介绍: Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信