S1187 Clinical and Economic Burden of Patients With HRS-AKI Treated With Current Standard of Care: Retrospective Analysis of Real World Data

Abstract

Introduction: Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a serious complication in cirrhotic patients, leading to significant morbidity and mortality. The purpose of this study was to evaluate clinical characteristics and treatment (Tx) response of HRS-AKI patients receiving currently available standard of care (SOC) treatment. Methods: Cerner Real World Data (from 113 U.S. health systems) was used to identify adult HRS-AKI (ICD-10, K76.7) patients hospitalized between 2016 and 2020. Patients with baseline serum creatinine (SCr) >1.5mg/dL treated with midodrine (MID), octreotide (OCT), or norepinephrine (NOR) were included. Tx response was assessed based on baseline SCr and post-Tx SCr readings (Day 14 or Tx discontinuation, whichever came first). Complete response was achieved if post-Tx SCr improved to ≤1.5 mg/dL; partial if decreased by ≥30% but remained >1.5 mg/dL; and no response if decreased by < 30%. Tx response by AKI stage using KDIGO guidelines and several comorbidities during hospitalization were also evaluated, including mechanical ventilation (MV), respiratory failure (RF), and fluid overload. Results: A total of 3,918 patients with HRS-AKI (64.5% male, mean age: 59.4±12.7 years) were identified. Most common precipitant included diuretic treatment (79.2%), paracentesis (55.7%), and gastrointestinal bleeding (29.7%). Majority of patients received MID or OCT (n=2,013, 51.4%) or MID+OCT without NOR (n=1,168, 29.8%) and 982 (25.1%) received NOR, regardless of other vasopressors. During hospitalization, 658 (16.8%) patients received MV, of whom 454 (11.6%) had RF. Additionally, 363 patients had RF without MV. Other common comorbid conditions included fluid overload (20.6%), pleural effusion (14.1%), and abdominal pain (9.6%). Complete response was observed in 683 patients overall (17.4%) and patients with AKI stage 1 or 2 (n=2,302) had a higher rate of complete response (13.0% vs 7.6%) and partial response (11.0% vs 8.0%) than patients with AKI stage 3. Additional patient and clinical characteristics are shown in Table. Conclusion: At least one in six HRS-AKI patients required mechanical ventilation, had RF and/or fluid overload during hospitalization. Current SOC for HRS-AKI was ineffective. The results also suggest an inverse relationship between KDIGO-staged AKI and rate of complete response, indicating a benefit for earlier diagnosis and treatment initiation. Table 1. - Additional Patient and Clinical Characteristics Characteristic N=3,918 Patient Demographics Age, years, mean ± SD 59.4 ± 12.7 Male, n (%) 2,528 (64.5) Ethnicity, n (%) White or Caucasian 3,243 (68.2) Black or African American 325 (6.8) Other 1,036 (21.8) Unknown 151 (3.2) Clinical Characteristics Baseline SCr*, mg/dL, mean ± SD 3.0 ± 1.7 Selected treatments, n (%) Midodrine or Octreotide without norepinephrine 2,013 (51.4) Midodrine and Octreotide without norepinephrine 1,168 (29.8) Norepinephrine (regardless of any other vasopressor) 982 (25.1) Etiology of liver disease*, n (%) Alcoholic cirrhosis/hepatitis 1,779 (45.4) Viral hepatitis 560 (14.3) NASH/NAFLD 1,728 (44.1) Precipitants of HRS-AKI*, n (%) Diuretic treatment 3,104 (79.2) Paracentesis 2,183 (55.7) Gastrointestinal bleeding 1,163 (29.7) Other infections 1,101 (28.1) Spontaneous bacterial peritonitis 690 (17.6) Hepatocellular carcinoma 374 (9.5) Use of mechanical ventilation and rate of respiratory failure, n (%) Mechanical ventilation 658 (16.8) Respiratory failure 454 (11.6) No respiratory failure 204 (5.2) No mechanical ventilation 3,260 (83.2) Respiratory failure 363 (9.3) No respiratory failure 2,897 (73.9) Response type by KDIGO-staged AKI No AKI, n (%) 1,103 (28.2) Complete response, n (% of no AKI) 345 (31.3) Partial response, n (% of no AKI) 146 (13.2) No response, n (% of no AKI) 612 (55.5) Stage 1 or 2 AKI, n (%) 2,302 (58.8) Complete response, n (% of Stage 1 or 2 AKI) 299 (13.0) Partial response, n (% of Stage 1 or 2 AKI) 244 (10.6) No response, n (% of Stage 1 or 2 AKI) 1,759 (76.4) Stage 3 AKI, n (%) 513 (13.1) Complete response, n (% of Stage 3 AKI) 39 (7.6) Partial response, n (% of Stage 3 AKI) 41 (8.0) No response, n (% of Stage 3 AKI) 433 (84.4) Comorbid conditions during hospitalization, n (%) Sepsis 846 (21.6) Respiratory failure 817 (20.9) Fluid overload 807 (20.6) Pleural effusion 553 (14.1) Abdominal pain 354 (9.0) Diarrhea 199 (5.1) Bradycardia 123 (3.1) Dyspnea 89 (2.3) Nausea 54 (1.4) *not mutually exclusive. Abbreviations: AKI, acute kidney injury; HRS, hepatorenal syndrome; KDIGO, Kidney Disease Improving Global Outcomes; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; SCr, serum creatinine; SD, standard deviation.