Background:
Hepatorenal syndrome (HRS) is considered a severe form of acute kidney injury (AKI)
that occurs in patients with cirrhosis and ascites. HRS diagnosis requires the exclusion
of common triggers of AKI to ensure true “hepatic” etiology of AKI.
Aims and methods:
A consecutive cohort of adult patients with cirrhosis, ascites and AKI episodes was
included. AKI and HRS were diagnosed according to the new criteria of the International
Ascites Club (HRS- AKI, IAC 2015). Other AKI episodes that did not meet HRS criteria
were recorded as severe “non-hepatic” but specifically-triggered AKI (sAKI, corresponding
to AKIN, KDIGO and ICA-AKI stages 2/3). Transplant-free survival (TFS) of HRS and
sAKI was assessed by Kaplan-Meier curves and compared by log-rank test.
Results:
Among 497 patients with cirrhosis and ascites, 64 individual cases of HRS (13%) and
138 individual cases of sAKI (28%) were recorded. No differences were found regarding
patient characteristics or survival [TFS: HRS: median 24 days (IQR: 4 – 405) vs. sAKI:
18 days (3 – 139); p = 0.908]. Patients with sAKI due to severe hypovolemia/shock
had the shortest TFS [8 days (3 – 40), n = 70], followed by sAKI after surgery/interventions
[32 days (3 – 109), n = 6] and infections [44 days (2 – 187), n = 30]. Conversely,
patients with acute-on-chronic renal failure [250 days (14-end of follow-up), n =
7] and nephrotoxic trigger [217 days (7 – 387), n = 11] showed a favorable TFS.
Conclusion:
Ascitic patients with HRS and sAKI showed similar characteristics and survival. However,
the trigger of “non-HRS” AKI significantly influenced prognosis, with shortest survival
in hypovolemia/shock-induced and surgery/intervention-associated sAKI. Thus, identification
of the specific sAKI trigger may help to adjust therapy and assess prognosis of cirrhotic
patients with ascites.
