Renal replacement therapy in critically ill liver cirrhotic patients-outcome and clinical implications

Area of Science:

• Nephrology
• Hepatology
• Critical Care Medicine

Background:

• Current guidelines advise against renal replacement therapy (RRT) for critically ill cirrhotic patients without liver transplant (LT) options.
• This study investigates the short-term and long-term outcomes of RRT in this patient population.

Purpose of the Study:

• To identify critically ill cirrhotic patients who may benefit from RRT.
• To evaluate the predictive value of various scoring systems for ICU mortality in patients undergoing RRT.
• To assess long-term renal recovery and successful bridging to LT.

Main Methods:

• A cohort of critically ill cirrhotic patients requiring RRT was followed for at least one year.
• CLIF-C ACLF, CLIF-SOFA, SOFA, and MELD scores were analyzed for their predictive value of ICU mortality.
• Renal recovery and LT bridging rates were assessed.

Main Results:

• 40% of patients required RRT, with significantly higher ICU, 28-day, 90-day, and 1-year mortality compared to those not requiring RRT.
• CLIF-C ACLF and CLIF-SOFA scores within 24 hours prior to RRT predicted ICU mortality.
• CLIF-C ACLF at 48 hours post-RRT initiation was the most suitable predictor of ICU mortality (AUC: 0.866).
• Patients with ≥5 organ failures (CLIF-SOFA) had 100% ICU mortality.
• 13% of RRT patients experienced renal recovery, and 14% were bridged to LT.

Conclusions:

• Mortality remains high in critically ill cirrhotics requiring RRT, regardless of LT availability.
• A small percentage of patients achieve renal recovery post-ICU discharge.
• CLIF-C ACLF and CLIF-SOFA scores can aid in identifying patients unlikely to benefit from RRT.