MON-235 ACUTE KIDNEY INJURY IN PATIENTS WITH LIVER CIRRHOSIS: INCIDENCES AND LONG-TERM OUTCOME IN MALAYSIA

Abstract

Acute kidney injury (AKI) is a predictor of poor prognosis among patients with cirrhosis. However, the incidence of AKI among Malaysian cirrhotic patients are relatively unknown. The objectives of this research are to identify the incidence, progression and outcomes of the cirrhotic patients with AKI at a tertiary hospital. This single-centre, retrospective cohort study was performed among all cirrhotic patients (defined as having histological or radiological evidence of cirrhosis; or evidence of portal hypertension) who were admitted to the Hepatology ward from 1st June 2015 till 31st December 2015. Cirrhotic patients with AKI as defined by KDIGO 2012 AKI criteria were recruited for this study. Demographic data, clinical data, renal outcomes and survival outcomes were collected for all patients admitted during the study period, one year and two years after the AKI episode from the hospital electronic medical records. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation and chronic kidney disease staging is based on KDIGO 2012 CKD criteria. Results were analyzed using SPSS Version 23. Of a total of 204 patients admitted with cirrhosis, 45 (22.1%) patients had AKI. Thirty two (71.1%) were male and 28 patients (62.2%) were of Malay ethnicity. The mean age of the cirrhotic AKI patients was 57.5±12.8 years. Twelve patients (26.7%) have unknown aetiology, followed by Hepatitis B with 11 patients (24.4%), Hepatitis C with 8 patients (17.8%), and alcoholic use disorder with 6 patients (13.3%). Twenty-five patients (55.6%) have Child Pugh Score C, followed by Child Pugh Score B with 18 patients (40.0%), and only two patients (4.4%) has Child Pugh Score A. Twenty-five (55.6%) patients had Stage 1 AKI, 12 (26.7%) patients had Stage 2 AKI and 8 (17.8%) patients had Stage 3 AKI. Most of Stage 3 AKI patients had Child Pugh Score C with 7 patients (87.5%). In contrast, patients with milder stages of AKI had less number of patients with Child Pugh Score C with 13 patients (52.0%) for Stage 1 AKI, and there were only 5 patients (41.7%) for Stage 2 AKI. There was significantly higher in-hospital mortality among cirrhotic patients with AKI compared those without AKI (13.3% vs 3.1% respectively; p=0.016). The mean eGFR at discharge was 46.4±24.5 ml/min/1.73m2. Three (6.7%) patients progressed to end-stage renal disease (ESRD). Fifteen (33.3%) patients developed recurrent episodes of AKI during subsequent admissions. Of those who were discharged (n=39), only thirty one (79.5%) patients survived beyond one year. The mean eGFR had decreased significantly to 32.3±18.32 ml/min/1.73m2 (p=0.002). Two (5.1%) patients progressed to end-stage renal disease (ESRD). The overall total mortality in cirrhotic patients with AKI in one year was 34.8% (n=16), while 11.1% (n=5) of the subjects had ESRD. The incidence of AKI among cirrhotic in-patients in our centre was 22.1%. Cirrhotic patients with AKI have a high in-hospital mortality rate of 13.3% and one year mortality of 34.8%. Early intensive medical intervention to prevent AKI in hospitalised cirrhotic patients is important to improve patient outcome.