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Association of Hepatorenal Syndrome-Acute Kidney Injury with Mortality in Patients with Cirrhosis Requiring Renal Replacement Therapy: Results from the HRS-HARMONY Consortium

Cama-Olivares, Augusto, Ouyang, Tianqi, Takeuchi, Tomonori, St. Hillien, Shelsea A., Robinson, Jevon E., Chung, Raymond T., Cullaro, Giuseppe, Karvellas, Constantine J., Levitsky, Josh, Orman, Eric S., Patidar, Kavish R., Regner, Kevin R., Saly, Danielle L., Sawinski, Deirdre, Sharma, Pratima, Teixeira, J. Pedro, Ufere, Nneka N., Velez, Juan Carlos Q., Wadei, Hani M., Wahid, Nabeel, Allegretti, Andrew S., Neyra, Javier A., Belcher, Justin M., HRS-HARMONY Consortium·2025·Kidney360
DOI 10.34067/kid.0000000589
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Abstract

Key Points: In patients with cirrhosis and AKI requiring renal replacement therapy (RRT), hepatorenal syndrome-AKI was not associated with an increased 90-day mortality when compared with other AKI etiologies. Etiology of AKI may not be a critical factor regarding decisions to trial RRT in acutely ill patients with cirrhosis and AKI. Although elevated, mortality rates in this study are comparable with those reported in general hospitalized patients with AKI requiring RRT. Background: While AKI requiring renal replacement therapy (AKI-RRT) is associated with increased mortality in heterogeneous inpatient populations, the epidemiology of AKI-RRT in hospitalized patients with cirrhosis is not fully known. Herein, we evaluated the association of etiology of AKI with mortality in hospitalized patients with cirrhosis and AKI-RRT in a multicentric contemporary cohort. Methods: This is a multicenter retrospective cohort study using data from the HRS-HARMONY consortium, which included 11 US hospital network systems. Consecutive adult patients admitted in 2019 with cirrhosis and AKI-RRT were included. The primary outcome was 90-day mortality, and the main independent variable was AKI etiology, classified as hepatorenal syndrome (HRS-AKI) versus other (non–HRS-AKI). AKI etiology was determined by at least two independent adjudicators. We performed Fine and Gray subdistribution hazard analyses adjusting for relevant clinical variables. Results: Of 2063 hospitalized patients with cirrhosis and AKI, 374 (18.1%) had AKI-RRT. Among them, 65 (17.4%) had HRS-AKI and 309 (82.6%) had non–HRS-AKI, which included acute tubular necrosis in most cases (62.6%). Continuous renal replacement therapy was used as the initial modality in 264 (71%) of patients, while intermittent hemodialysis was used in 108 (29%). The HRS-AKI (versus non–HRS-AKI) group received more vasoconstrictors for HRS management (81.5% versus 67.9%), whereas the non–HRS-AKI group received more mechanical ventilation (64.3% versus 50.8%) and more continuous renal replacement therapy (versus intermittent hemodialysis) as the initial RRT modality (73.9% versus 56.9%). In the adjusted model, HRS-AKI (versus non–HRS-AKI) was not independently associated with increased 90-day mortality (subdistribution hazard ratio, 1.36; 95% confidence interval, 0.95 to 1.94). Conclusions: In this multicenter contemporary cohort of hospitalized adult patients with cirrhosis and AKI-RRT, HRS-AKI was not independently associated with an increased risk of 90-day mortality when compared with other AKI etiologies. The etiology of AKI appears less relevant than previously considered when evaluating the prognosis of hospitalized adult patients with cirrhosis and AKI requiring RRT.

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Research works printed but not linked: 50

  1. Ginès, 2009, Renal failure in cirrhosis, N Engl J Med., 361, 1279, 10.1056/NEJMra0809139 · DOI · Paper page
  2. Nadim, 2023, Acute kidney injury in patients with cirrhosis, N Engl J Med., 388, 733, 10.1056/NEJMra2215289 · DOI
  3. Tandon, 2016, Relevance of new definitions to incidence and prognosis of acute kidney injury in hospitalized patients with cirrhosis: a retrospective population-based cohort study, PLoS One., 11, e0160394, 10.1371/journal.pone.0160394 · DOI
  4. Huelin, 2017, Validation of a staging system for acute kidney injury in patients with cirrhosis and association with acute-on-chronic liver failure, Clin Gastroenterol Hepatol., 15, 438, 10.1016/j.cgh.2016.09.156 · DOI
  5. Wong, 2013, New consensus definition of acute kidney injury accurately predicts 30-day mortality in patients with cirrhosis and infection, Gastroenterology., 145, 1280, 10.1053/j.gastro.2013.08.051 · DOI
  6. Piano, 2013, Evaluation of the Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites, J Hepatol., 59, 482, 10.1016/j.jhep.2013.03.039 · DOI
  7. Garcia-Tsao, 2008, Acute kidney injury in cirrhosis, Hepatology., 48, 2064, 10.1002/hep.22605 · DOI
  8. Cholongitas, 2009, Cirrhotics admitted to intensive care unit: the impact of acute renal failure on mortality, Eur J Gastroenterol Hepatol., 21, 744, 10.1097/MEG.0b013e328308bb9c · DOI
  9. de Carvalho, 2012, Acute kidney injury network criteria as a predictor of hospital mortality in cirrhotic patients with ascites, J Clin Gastroenterol., 46, e21, 10.1097/MCG.0b013e31822e8e12 · DOI
  10. D’Amico, 2006, Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies, J Hepatol., 44, 217, 10.1016/j.jhep.2005.10.013 · DOI · Paper page
  11. Belcher, 2013, Association of AKI with mortality and complications in hospitalized patients with cirrhosis, Hepatology., 57, 753, 10.1002/hep.25735 · DOI
  12. Fede, 2012, Renal failure and cirrhosis: a systematic review of mortality and prognosis, J Hepatol., 56, 810, 10.1016/j.jhep.2011.10.016 · DOI
  13. Jagarlamudi, 2020, Acute kidney injury: prediction, prognostication and optimisation for liver transplant, Hepatol Int., 14, 167, 10.1007/s12072-020-10018-0 · DOI
  14. 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
  15. Davenport, 2017, Acute kidney injury in acute-on-chronic liver failure: where does hepatorenal syndrome fit?, Kidney Int., 92, 1058, 10.1016/j.kint.2017.04.048 · DOI
  16. Gupta, 2021, Acute kidney injury and hepatorenal syndrome in cirrhosis, World J Gastroenterol., 27, 3984, 10.3748/wjg.v27.i26.3984 · DOI
  17. Cullaro, 2022, Acute kidney injury in patients with liver disease, Clin J Am Soc Nephrol., 17, 1674, 10.2215/CJN.03040322 · DOI
  18. Staufer, 2017, Renal replacement therapy in critically ill liver cirrhotic patients-outcome and clinical implications, Liver Int., 37, 843, 10.1111/liv.13389 · DOI
  19. Nadkarni, 2016, National trends of acute kidney injury requiring dialysis in decompensated cirrhosis hospitalizations in the United States, Hepatol Int., 10, 525, 10.1007/s12072-016-9706-9 · DOI
  20. McPhail, 2018, Incidence and outcomes for patients with cirrhosis admitted to the United Kingdom critical care units, Crit Care Med., 46, 705, 10.1097/CCM.0000000000002961 · DOI
  21. 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
  22. Gonwa, 2012, The challenges of providing renal replacement therapy in decompensated liver cirrhosis, Blood Purif., 33, 144, 10.1159/000334149 · DOI
  23. Bagshaw, 2008, Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: a meta-analysis, Crit Care Med., 36, 610, 10.1097/01.CCM.0B013E3181611F552 · DOI
  24. Wald, 2023, Initiation of continuous renal replacement therapy versus intermittent hemodialysis in critically ill patients with severe acute kidney injury: a secondary analysis of STARRT-AKI trial, Intensive Care Med., 49, 1305, 10.1007/s00134-023-07211-8 · DOI
  25. Witzke, 2004, Which patients benefit from hemodialysis therapy in hepatorenal syndrome?, J Gastroenterol Hepatol., 19, 1369, 10.1111/j.1440-1746.2004.03471.x · DOI
  26. Wong, 2005, Survival of liver transplant candidates with acute renal failure receiving renal replacement therapy, Kidney Int., 68, 362, 10.1111/j.1523-1755.2005.00408.x · DOI
  27. Allegretti, 2015, Prognosis of acute kidney injury and hepatorenal syndrome in patients with cirrhosis: a prospective cohort study, Int J Nephrol., 2015, 108139, 10.1155/2015/108139 · DOI
  28. Martín-Llahí, 2011, Prognostic importance of the cause of renal failure in patients with cirrhosis, Gastroenterology., 140, 488, 10.1053/j.gastro.2010.07.043 · DOI · Paper page
  29. Allegretti, 2018, Prognosis of patients with cirrhosis and AKI who initiate RRT, Clin J Am Soc Nephrol., 13, 16, 10.2215/CJN.03610417 · DOI
  30. Saraiva, 2020, Continuous renal replacement therapy in critically ill patients with acute on chronic liver failure and acute kidney injury: a retrospective cohort study, Clin Nephrol., 93, 187, 10.5414/CN109983 · DOI
  31. Angeli, 2015, Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites, Gut., 64, 531, 10.1136/gutjnl-2014-308874 · DOI
  32. 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
  33. Jepsen, 2015, The clinical course of cirrhosis: the importance of multistate models and competing risks analysis, Hepatology., 62, 292, 10.1002/hep.27598 · DOI
  34. De Corte, 2016, Long-term outcome in ICU patients with acute kidney injury treated with renal replacement therapy: a prospective cohort study, Crit Care., 20, 256, 10.1186/s13054-016-1409-z · DOI
  35. Liang, 2016, Modality of RRT and recovery of kidney function after AKI in patients surviving to hospital discharge, Clin J Am Soc Nephrol., 11, 30, 10.2215/CJN.01290215 · DOI
  36. Lo, 2009, Dialysis-requiring acute renal failure increases the risk of progressive chronic kidney disease, Kidney Int., 76, 893, 10.1038/ki.2009.289 · DOI · Paper page
  37. Wald, 2009, Chronic dialysis and death among survivors of acute kidney injury requiring dialysis, JAMA., 302, 1179, 10.1001/jama.2009.1322 · DOI
  38. Bonnassieux, 2018, Renal replacement therapy modality in the ICU and renal recovery at hospital discharge, Crit Care Med., 46, E102, 10.1097/CCM.0000000000002796 · DOI
  39. Palevsky, 2008, Intensity of renal support in critically ill patients with acute kidney injury, N Engl J Med., 359, 7, 10.1056/NEJMoa0802639 · DOI · Paper page
  40. Allegretti, 2013, Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study, Crit Care., 17, R109, 10.1186/cc12780 · DOI
  41. Mazumder, 2021, Black patients with cirrhosis have higher mortality and lower transplant rates: results from a metropolitan cohort study, Hepatology., 74, 926, 10.1002/hep.31742 · DOI
  42. Nephew, 2023, Trends in racial and ethnic disparities in the receipt of lifesaving procedures for hospitalized patients with decompensated cirrhosis in the US, 2009-2018, JAMA Netw Open., 6, e2324539, 10.1001/jamanetworkopen.2023.24539 · DOI
  43. Moylan, 2008, Disparities in liver transplantation before and after introduction of the MELD score, JAMA., 300, 2371, 10.1001/jama.2008.720 · DOI · Paper page
  44. Atiemo, 2019, The hispanic paradox in patients with liver cirrhosis: current evidence from a large regional retrospective cohort study, Transplantation., 103, 2531, 10.1097/TP.0000000000002733 · DOI
  45. Del Risco-Zevallos, 2022, Management of acute renal replacement therapy in critically ill cirrhotic patients, Clin Kidney J., 15, 1060
  46. Velez, 2021, Patients with hepatorenal syndrome should be dialyzed?, Kidney360., 2, 406, 10.34067/KID.0006952020 · DOI
  47. 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
  48. Nadim, 2016, Management of the critically ill patient with cirrhosis: a multidisciplinary perspective, J Hepatol., 64, 717, 10.1016/j.jhep.2015.10.019 · DOI
  49. Belcher, 2023, Hepatorenal syndrome: pathophysiology, diagnosis, and treatment, Med Clin North Am., 107, 781, 10.1016/j.mcna.2023.03.009 · DOI
  50. Wong, 2015, Outcomes of patients with cirrhosis and hepatorenal syndrome type 1 treated with liver transplantation, Liver Transplant., 21, 300, 10.1002/lt.24049 · DOI

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Metadata

Authors
Cama-Olivares, A., Ouyang, T., Takeuchi, T., St. Hillien, S. A., Robinson, J. E., Chung, R. T., Cullaro, G., Karvellas, C. J., Levitsky, J., Orman, E. S., Patidar, K. R., Regner, K. R., Saly, D. L., Sawinski, D., Sharma, P., Teixeira, J. P., Ufere, N. N., Velez, J. C. Q., Wadei, H. M., Wahid, N., Allegretti, A. S., Neyra, J. A., Belcher, J. M., & HRS-HARMONY Consortium
Venue
Kidney360
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2024-09-30
Volume
6
Issue
2
Pages
247-256
ISSN
2641-7650
DOI
10.34067/kid.0000000589
Cited by
13
References
0
Language
en
Licence
creativecommons.org/licenses/by/4.0/ (unspecified)

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CoChat. (2026). Citation check: Association of Hepatorenal Syndrome-Acute Kidney Injury with Mortality in Patients with Cirrhosis Requiring Renal Replacement Therapy: Results from the HRS-HARMONY Consortium. https://app.cochat.ai/papers/10.34067/kid.0000000589
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Cama-Olivares, A., Ouyang, T., Takeuchi, T., St. Hillien, S. A., Robinson, J. E., Chung, R. T., Cullaro, G., Karvellas, C. J., Levitsky, J., Orman, E. S., Patidar, K. R., Regner, K. R., Saly, D. L., Sawinski, D., Sharma, P., Teixeira, J. P., Ufere, N. N., Velez, J. C. Q., Wadei, H. M., . . . HRS-HARMONY Consortium. (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. https://doi.org/10.34067/kid.0000000589

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