Acute kidney injury incidence and clinical features: Refractory versus non-refractory ascites

Outpatients with cirrhosis, ascites and minor acute serum creatinine (sCr) changes could have been missed as having acute kidney injury (AKI). This study aims to assess the incidence, clinical features of all AKI stages amongst patients with cirrhosis and various ascites severities.

Retrospective study of patients with cirrhosis and ascites from April 2020 to March 2021. Data collected included demographics, clinical features, medications, AKI development, and 6-month follow-up outcomes. Multivariate analysis for factors predicting AKI development and resolution was done.

115 (38 % of 306) with refractory ascites (RA) were compared to 191 with non-refractory ascites (n-RA), 86 % were outpatients. RA patients had higher baseline MELD-Na (18.1 ± 4.7 vs. 17.2 ± 6.8 in n-RA, p = 0.01) but had similar cirrhosis complications. 98 % RA patients required regular large volume paracenteses (LVP) (p < 0.001 vs. n-RA). AKI occurred in 39 % of RA and 19 % of n-RA patients (p<0.001). Most were stage 1 AKI, treated with albumin ± vasoconstrictor with similar response. 27 % of AKI in n-RA were classified as type 1 HRS (vs.20 % in RA, p < 0.001). Baseline MELD-Na (p = 0.01) predicted AKI development; lower peak sCr predicted AKI resolution (p = 0008). 11 (3.6 %) n-RA and 22 (19 %) RA patients developed acute-on-chronic liver failure (ACLF), with 86 % RA patients having renal failure as part of the ACLF syndrome (p < 0.001 vs. n-RA patients). Both groups had similar 6-month survival.

AKI occurs not infrequently in n-RA patients who are mostly treated as outpatients. Therefore, patients with n-RA need to be monitored closely so to allow prompt diagnosis and treatment of AKI.