A Study of Acute Kidney Injury (AKI) in Hospitalised Chronic Liver Disease (CLD) Patients: A Single Centre Experience

Abstract

Background and Aim: Acute kidney injury (AKI) is a common complication of chronic liver disease (CLD). We performed a prospective study to evaluate the spectrum of renal injury among hospitalised decompensated cirrhosis (DC) patients and their impact on survival. Methods: This study was conducted in consecutive DC patients hospitalized in Gastroenterology Department, SCB Medical College from October 2016 to February 2017. AKI was defined as per International Club of Ascites criteria (ICA-AKI). Demographic, clinical and laboratory parameters were compared among patients with and without AKI. 28 days survival was also compared. Results: Eighty two subjects were enrolled out of which 19 (23%) had AKI; 37% (n = 7) with stage 1, 47% (n = 9) stage 2 and 16% (n = 3) with stage 3 AKI.ALD was predominant cause of CLD among patients with AKI (16 of 19). In 11 (58%), infection was the precipitating factor for AKI and in 7 (37%) AKI was due to diuretic/lactulose. Patients with AKI had higher CTP (12.56 ± 3.24 vs 10.05 ± 2.95, P < 0.001) and MELD (24.70 ± 8.86 vs 15.50 ± 5.27, P < 0.001) than those without. Leucocyte counts, serum sodium, total bilirubin, albumin, INR, urine sodium were comparable between the two groups. Further, patients with AKI had longer hospital stay (8.9 ± 6.21 vs 4.52 ± 1.28; P < 0.001) and lower 28 days survival (63% vs 93%; P < 0.001). Besides in patients with AKI of stages 1–3 there was difference in overall mortality (43% vs 78% vs 100%; P < 0.006) and 28 days survival (100% vs 56% vs 33%; P < 0.001). Conclusions: In our institution, one-fourth DC patients had AKI. Alcohol was the predominant cause of underlying CLD in them and over half of AKI was precipitated by infection. Patients with AKI had significantly higher CTP, MELD, longer hospital stay and lower 4 weeks survival. The authors have none to declare.