S1175 Clinical Response to Treatment for Acute Kidney Injury (AKI) in Patients With Cirrhosis

Abstract

INTRODUCTION: The development of acute kidney injury (AKI) is associated with increase in morbidity/mortality in patients with cirrhosis. Revised ICA criteria now classify AKI into three stages (1: Cr increase by 0.3 mg/dl or 50–100% increase from baseline; 2: Cr increase by 100-200%;3: Cr increase by > 200% or Cr > 4 mg/dl) with management based on stage and response to therapy. AIM: To characterize cirrhotic patients admitted with AKI and response to therapy based on ICA AKI stages. METHODS: Retrospective study of inpatients with cirrhosis at single center from 1/2015–05/2019 who received treatment for AKI. Treatment was administered at the discretion of the treating hepatologist and included volume expansion (VE; albumin, lactated ringer, normal saline), vasoconstrictors (VC; midodrine or norepinephrine), and octreotide. Progression and regression of AKI and incidence of liver transplant were analyzed. RESULTS: One hundred seventy-nine patients (97M, 82F, mean age 59) were reviewed (40% Caucasians, 35% Hispanics, 9% Asians, 3% Black). Main cirrhosis etiologies included alcohol (36%), HCV (19%), NASH (11%), cryptogenic (8%) and others. At presentation mean MAP was 69 mmHg and mean Na MELD 31. Mean serum values included Na 130 mEq/l, TB 9 mg/dl, creatinine 2.0 mg/dL, INR 2.0. 135/179 patients had AKI present at admission. 104 (58%) patients developed Stage 1, 43 (24%) developed Stage 2, 32 (18%) developed Stage 3 AKI. 69 patients received VE only, 110 patients received VC and VE (Table 1). In VC group, 37% remained in same stage AKI as at admission, 45% progressed to higher stage AKI, 18% regressed to lower AKI stage (Table 2). Peak stages of AKI were Stage 1 (18%), Stage 2 (16%), and Stage 3 (66%). In VE group, 39% developed regression of AKI, 39% had no change, 22% had progression. Peak stages of AKI were Stage 1 (38%), Stage 2 (23%), Stage 3 (39%). 34% received liver transplant, 49% died, 4% were LTFU, 13% alive. Patients who received VE for AKI had higher response to treatment (P < 0.05) compared to VC group. Patients with AKI stage 2 and stage 3 at admission had higher odds of remaining in same stage of AKI regardless of receiving vasoconstrictors (table 3). Patients with lower MAP at presentation had higher mortality rate (P = 0.002). CONCLUSION: Development of AKI is associated with high rate of mortality and need for LT. Regression to lower stage of AKI noted in 20/179 (11%) of patients receiving vasoconstrictors. The lowest response rates to VC were seen in those with Stage 3 AKI.Table 1Table 2Table 3