This article is more than 5 years old. Information may no longer be current.

Minor acute kidney injury reduced survival rate among patients with cirrhosis

Even small increases in serum creatinine levels among patients with decompensated cirrhosis can have a detrimental effect on survival rates, according to recent results.

Researchers performed blood work on 90 patients with cirrhosis, ascites, a baseline serum creatinine level less than 110 mcmol/L and no indication of structural renal disease. The blood work included a full blood count, as well as data on biochemistry and liver function. A mean follow-up of 14.05±1.07 months was conducted with blood work repeated every 4 to 6 weeks, with clinical evaluation every 4 months for acute kidney injury (AKI) or other adverse events.

During follow-up, 49 patients experienced 82 incidences of kidney injury, 73 of which were resolved. Most AKI incidences had precipitating factors (85%), with the most common including bacterial infections and large volume paracentesis. All episodes had a mean peak serum creatinine level within normal laboratory range, with a mean peak less than 133 mcmol/L. However, after 8 and 12 months of follow-up, creatinine levels slowly increased while mean arterial pressure gradually reduced, both of which were associated with a reduction in survival rate compared with patients without AKI. The end-stage liver disease score among patients who developed AKI was significantly different at 12 months from patients who did not (P<.05).

Eight patients with AKI died during the study, compared with one non-AKI patient. Causes of death within the AKI group included sepsis, multi-organ failure, cardiac disease, variceal bleed and hepatoma. The survival rate among AKI patients was significantly lower than among non-AKI patients (P=.049).

“It appears that minor increases in serum creatinine, even when the peak serum creatinine values are still within the laboratory’s normal range, are clinically relevant and are associated with progressively worsening renal function and increased mortality,” the researchers concluded. “Every effort should be made to avoid and promptly treat renal dysfunction with volume expansion, even if mild, in patients with cirrhosis and ascites. … the next step would be to investigate whether earlier treatment of unresolved AKI episodes would lead to improved patient outcomes.”