Outcomes of renal dysfunction in patients with acute liver failure

Although acute kidney injury (AKI) often accompanies acute liver failure (ALF), its impact on long-term outcome is unknown.

This study examines the incidence, severity and outcomes of AKI in patients with ALF.

A total of 134 ALF patients treated at Hannover Medical School between 1995 and 2013 were retrospectively analyzed.

Fifty-four ALF patients (40.3%) demonstrated AKI, as defined by the acute kidney injury network (AKIN) classification, on intensive care unit (ICU) admission, and 85 patients (63.4%) developed AKI prior to ALF recovery, emergency liver transplantation (ELT) or death. AKI severity was closely associated with other end-organ damage (p < 0.001). Follow-up creatinine levels in survivors were increased compared to baseline levels (76 versus 64 µmol/l, p = 0.003). One-hundred-and-three (76.9%) patients reached the combined endpoint of ELT or death, and 42 (31.3%) patients died within 28 days. AKIN stage 3 at ICU admission was the strongest independent predictor of 28-day overall mortality (hazard ratio 3.48, 95% confidence interval 1.75-6.93, p < 0.001) and ELT or death (hazard ratio 2.52, 95% confidence interval 1.60-3.96, p < 0.001).

AKI is a frequent complication in ALF that correlates with remote organ damage and long-term creatinine levels and independently predicts outcome.