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  3. Research Domains
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  9. Predictive And Prognostic Markers
  11. Prognosis Of Transplant-ineligible Patients With Cirrhosis And Acute Kidney Injury Who Initiate Renal Replacement Therapy.
  1. Home
  3. Research Domains
  5. Biomedical And Clinical Sciences
  7. Oncology And Carcinogenesis
  9. Predictive And Prognostic Markers
  11. Prognosis Of Transplant-ineligible Patients With Cirrhosis And Acute Kidney Injury Who Initiate Renal Replacement Therapy.

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Prognosis of Transplant-Ineligible Patients with Cirrhosis and Acute Kidney Injury Who Initiate Renal Replacement Therapy.

Paige McLean Diaz1, Danielle L Saly2, Nora Horick3

  • 1Department of Gastroenterology, Hepatology & Nutrition, Center for Liver Disease, University of Chicago Medicine, Chicago, IL, USA.

Digestive Diseases and Sciences
|August 31, 2024

View abstract on PubMed

Summary
This summary is machine-generated.

Renal replacement therapy (RRT) offers limited survival benefit for transplant-ineligible cirrhosis patients with acute kidney injury. Structured decision-making and communication are crucial for this population facing high mortality.

Keywords:
Acute on chronic liver failureDialysisEnd-stage liver diseasePalliative care

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Area of Science:

  • Nephrology
  • Hepatology
  • Critical Care Medicine

Background:

  • Limited data exists for guiding dialysis decisions in transplant-ineligible cirrhosis patients.
  • Acute kidney injury (AKI) is a common complication in this patient group.

Purpose of the Study:

  • To describe the processes, predictors, and outcomes of renal replacement therapy (RRT) initiation.
  • To evaluate survival and renal recovery in transplant-ineligible cirrhosis patients with AKI.
  • To examine end-of-life care outcomes for patients receiving RRT.

Main Methods:

  • Mixed-methods study of a retrospective cohort (n=372).
  • Included transplant-ineligible inpatients with cirrhosis and AKI (hepatorenal syndrome or acute tubular necrosis).
  • Survival analyses and medical record review were performed.
Palliative hepatology

Main Results:

  • 266 patients received RRT; 106 did not.
  • RRT initiation was associated with improved median survival (12.5 days vs. 2.0 days) and 6-month survival (15% vs. 0%).
  • Patients receiving RRT were more likely to die in the ICU; hepatorenal syndrome-AKI patients had higher RRT dependence at 6 months.

Conclusions:

  • Most transplant-ineligible cirrhosis patients initiated on RRT experienced short-term mortality.
  • Approximately 15% of RRT patients survived at 6 months.
  • There is a critical need for structured clinical processes for serious illness communication and RRT decision-making in this population.