Student or educator? Sign up with your school email and get 6 months of Pro free.
CoChat
Sign Up
Cited by 0

The DOI matches its Crossref record; 1 of the 1 references it cites were found in a registry or an index.

Epidemiology of Critically Ill Patients With Cirrhosis Undergoing Continuous Renal Replacement Therapy: A Contemporaneous Parallel Analysis of the HRS-HARMONY and CRRTnet Registries

Karvellas, Constantine J., Lambert, Joshua, Ouyang, Tianqi, Bagshaw, Sean M., Cullaro, Giuseppe, Fricker, Zachary, Frederick, Todd, Goldstein, Stuart L., House, Andrew A., Juncos, Luis A., Heung, Michael, Patidar, Kavish R., Rewa, Oleksa G., Robinson, Jevon E., Teixeira, J. Pedro, Wadei, Hani, Neyra, Javier A., Allegretti, Andrew S., CRRTnet and HRS-HARMONY Consortia·2026·Critical Care Medicine
DOI 10.1097/ccm.0000000000007363
Open this paper in CoChat — free account

Abstract

Objectives: Describe the epidemiology of patients with cirrhosis/acute-on-chronic liver failure (ACLF) receiving continuous renal replacement therapy (CRRT) pertaining to process factors including renal replacement dose, modality, and circuit anticoagulation. Setting: Academic tertiary care hospitals in the United States and Canada. Design and Patients: We performed a parallel study of contemporaneous data from the HARMONY and CRRT network (CRRTnet) databases to describe the epidemiology and process of CRRT care of cirrhosis/ACLF patients receiving CRRT in the ICU. We evaluated clinical and CRRT process factors (dialysis dose, anticoagulation) with the primary outcome of in-hospital mortality. Interventions: None. Measurements and Main Results: The HARMONY cohort ( n = 245; median age, 57 yr; 41% female) and CRRTnet cohort ( n = 206; 58 yr; 39% female) demonstrated similar overall survival to hospital discharge (HARMONY, 34%; CRRTnet, 30%). In HARMONY, the two most common causes of acute kidney injury (AKI) requiring CRRT were acute tubular necrosis (73%) and hepatorenal syndrome-AKI (13%), with no significant difference between survivors and nonsurvivors ( p = 0.24). In HARMONY, higher chronic liver failure-C ACLF scores (hazard ratio, 1.03 [95% CI, 1.01–1.05]; p < 0.001) were independently associated with increased in-hospital mortality. In CRRTnet, the most common CRRT modality was continuous venovenous hemodiafiltration (83.8%), and the most common anticoagulation strategy was regional citrate anticoagulation (58.0%) or no anticoagulation (35.8%). CRRT prescribed dose greater than 30 mL/kg/hr was independently associated with higher in-hospital mortality (multivariable regression; odds ratio, 2.69; 95% CI, 1.3–5.64; p = 0.01). Of survivors in CRRTnet, 64% were transitioned to intermittent hemodialysis (IHD) before hospital discharge. Conclusions: Critically ill cirrhosis/ACLF patients initiated on CRRT in the absence of liver transplantation had high in-hospital mortality. These patients were prescribed higher initial CRRT doses (median total effluent > 30 mL/kg/hr), with higher CRRT dose independently associated with increased in-hospital mortality. Of ICU survivors, 64% were transitioned to IHD at ICU discharge. Despite concerns for citrate toxicity, citrate regional anticoagulation was commonly employed in these patients.

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1097/ccm.0000000000007363

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

Research works printed but not linked: 27

  1. Angeli, 2015, Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the International Club of Ascites., J Hepatol, 62, 968, 10.1016/j.jhep.2014.12.029 · DOI
  2. Moreau, 2013, Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis., Gastroenterology, 144, 1426, 10.1053/j.gastro.2013.02.042 · DOI
  3. Mendez-Guerrero, 2021, Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit., Ann Hepatol, 22, 100270, 10.1016/j.aohep.2020.09.014 · DOI
  4. Piano, 2017, Incidence, predictors and outcomes of acute-on-chronic liver failure in outpatients with cirrhosis., J Hepatol, 67, 1177, 10.1016/j.jhep.2017.07.008 · DOI
  5. Cao, 2020, The use of NACSELD and EASL-CLIF classification systems of ACLF in the prediction of prognosis in hospitalized patients with cirrhosis., Am J Gastroenterol, 115, 2026, 10.14309/ajg.0000000000000771 · DOI
  6. Angeli, 2019, News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document., J Hepatol, 71, 811, 10.1016/j.jhep.2019.07.002 · DOI · Paper page
  7. Nadim, 2024, Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting., J Hepatol, 81, 163, 10.1016/j.jhep.2024.03.031 · DOI
  8. Nadim, 2012, Hepatorenal syndrome: The 8th International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group., Crit Care, 16, R23, 10.1186/cc11188 · DOI
  9. Jeon, 2021, Clinical outcomes and prognostic factors of mortality in liver cirrhosis patients on continuous renal replacement therapy in two tertiary hospitals in Korea., Kidney Res Clin Pract, 40, 687, 10.23876/j.krcp.21.033 · DOI
  10. Karvellas, 2024, AASLD practice guidance on acute-on-chronic liver failure and the management of critically ill patients with cirrhosis., Hepatology, 79, 1463, 10.1097/HEP.0000000000000671 · DOI
  11. Szamosfalvi, 2021, Regional citrate anticoagulation protocol for patients with presumed absent citrate metabolism., Kidney360, 2, 192, 10.34067/KID.0005342020 · DOI
  12. Belcher, 2014, Is there a role for dialysis in patients with hepatorenal syndrome who are not liver transplant candidates?, Semin Dial, 27, 288, 10.1111/sdi.12224 · DOI
  13. Allegretti, 2018, Prognosis of patients with cirrhosis and AKI who initiate RRT., Clin J Am Soc Nephrol, 13, 16, 10.2215/CJN.03610417 · DOI
  14. Fagundes, 2013, A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis., J Hepatol, 59, 474, 10.1016/j.jhep.2013.04.036 · DOI
  15. Patidar, 2023, Incidence and outcomes of acute kidney injury including hepatorenal syndrome in hospitalized patients with cirrhosis in the US., J Hepatol, 79, 1408, 10.1016/j.jhep.2023.07.010 · DOI
  16. Cama-Olivares, 2025, Association of hepatorenal syndrome-acute kidney injury with mortality in patients with cirrhosis requiring renal replacement therapy: Results from the HRS-HARMONY Consortium., Kidney360, 6, 247, 10.34067/KID.0000000589 · DOI · Paper page
  17. Heung, 2017, CRRTnet: A prospective, multi-national, observational study of continuous renal replacement therapy practices., BMC Nephrol, 18, 222, 10.1186/s12882-017-0650-2 · DOI
  18. Rewa, 2023, Epidemiology and outcomes of AKI treated with continuous kidney replacement therapy: The Multicenter CRRTnet Study., Kidney Med, 5, 100641, 10.1016/j.xkme.2023.100641 · DOI
  19. Vasquez Jimenez, 2021, Dose of continuous renal replacement therapy in critically ill patients: A bona fide quality indicator., Nephron, 145, 91, 10.1159/000512846 · DOI
  20. Austin, 2017, Practical recommendations for reporting Fine-Gray model analyses for competing risk data., Stat Med, 36, 4391, 10.1002/sim.7501 · DOI
  21. Diaz, 2024, Prognosis of transplant-ineligible patients with cirrhosis and acute kidney injury who initiate renal replacement therapy., Dig Dis Sci, 69, 3710, 10.1007/s10620-024-08623-2 · DOI
  22. Griffin, 2019, Continuous renal replacement therapy dosing in critically ill patients: A quality improvement initiative., Am J Kidney Dis, 74, 727, 10.1053/j.ajkd.2019.06.013 · DOI
  23. Stevens, 2013, Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline., Ann Intern Med, 158, 825, 10.7326/0003-4819-158-11-201306040-00007 · DOI · Paper page
  24. Kramer, 2003, Citrate pharmacokinetics and metabolism in cirrhotic and noncirrhotic critically ill patients., Crit Care Med, 31, 2450, 10.1097/01.CCM.0000084871.76568.E6 · DOI
  25. Zarbock, 2020, Effect of regional citrate anticoagulation vs systemic heparin anticoagulation during continuous kidney replacement therapy on dialysis filter life span and mortality among critically ill patients with acute kidney injury: A randomized clinical trial., JAMA, 324, 1629, 10.1001/jama.2020.18618 · DOI
  26. Kampelos, 2024, A combination of clot formation abnormalities in thromboelastometry has a high prognostic value in patients with acute-on-chronic liver failure., Eur J Gastroenterol Hepatol, 36, 76, 10.1097/MEG.0000000000002630 · DOI
  27. Karvellas, 2024, Initiation of renal replacement therapy in critically-ill patients with cirrhosis/chronic liver disease: A secondary analysis of STARRT-AKI trial., Hepatology, 80, S1987

Metadata

Authors
Karvellas, C. J., Lambert, J., Ouyang, T., Bagshaw, S. M., Cullaro, G., Fricker, Z., Frederick, T., Goldstein, S. L., House, A. A., Juncos, L. A., Heung, M., Patidar, K. R., Rewa, O. G., Robinson, J. E., Teixeira, J. P., Wadei, H., Neyra, J. A., Allegretti, A. S., & Consortia, C. A. H.-H.
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2026-09-17
ISSN
  • 0090-3493
  • 1530-0293
DOI
10.1097/ccm.0000000000007363
Cited by
0
References
1
Language
en

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Data sources

Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.