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Analysis of the high incidence of acute kidney injury associated with acute-on-chronic liver failure

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Abstract

Background

To investigate the incidence, risk, and prognostic factors of acute kidney injury (AKI) in acute-on-chronic liver failure (ACLF) patients.

Methods

A total of 188 patients were prospectively included and divided into AKI and non-AKI groups. Patients were followed at 1, 3, 7, 14, 28, 60, and 90 days after the onset of AKI. Significant risk factors were screened by univariate and Cox multivariate survival analyses to confirm the independent risk factors for 30- or 90-day mortality and the 90-day renal function recovery rate.

Results

A total of 98 AKI cases (52.1%, [95% CI 44.9–59.3%]) occurred and the risk factors for AKI development in ACLF patients were age > 50 years (p = 0.009) and albumin (Alb) levels < 32 g/L (p = 0.007). The 30- and 90-day mortalities were significantly higher in the AKI than in the non-AKI group (79.6 vs 41.1%, 82.7 vs 56.7%, p < 0.05). AKI highest staging occurring within < 4 days of its onset and spontaneous peritonitis as well as MELD scores > 27 were independent risk factors for 30- and 90-day mortalities of ACLF AKI patients. AKI stage 3 and age > 52 years were independent risk factors for non-renal function recovery in ACLF patients with AKI.

Conclusions

ACLF patients had a high incidence of AKI, which correlated with 30- and 90-day mortalities.

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Acknowledgements

This study was supported by the Shanghai Municipal Commission of Health and Family Planning (2013SY048); and Science and Technology Commission of Shanghai Municipality (14DZ2260200, the project of Shanghai Key Laboratory of Kidney and Blood Purification).

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Authors and Affiliations

  1. Hemopurification Center, Shanghai Public Health Clinical Center, No. 921 Tongxin Road, Shanghai, 200083, People’s Republic of China

    Nan Chen

  2. Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, People’s Republic of China

    Xiaohong Chen, Xiaoqiang Ding & Jie Teng

  3. Shanghai Institute for Kidney and Dialysis, No 180 Fenglin Road, Shanghai, 200032, People’s Republic of China

    Xiaohong Chen, Xiaoqiang Ding & Jie Teng

  4. Shanghai Key Laboratory of Kidney and Blood Purification, No 180 Fenglin Road, Shanghai, 200032, People’s Republic of China

    Xiaohong Chen, Xiaoqiang Ding & Jie Teng

  5. Department of Nephrology, Xiamen Branch, Zhongshan Hospital, Fudan University, No. 668 Jinhu Road, Xiamen, Fujian, 361015, People’s Republic of China

    Jie Teng

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  1. Nan Chen
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Correspondence to Jie Teng.

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Conflict of interest

Nan Chen, Xiaohong Chen, Xiaoqiang Ding, and Jie Teng declare that they have no competing conflicts of interest.

Ethical approval

This study was approved by the ethical committee of the Shanghai Public Health Clinical Center (SHAPHC). The study was carried out in accordance with the approved guidelines and written informed consents were obtained from all participants included in the study.

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Cite this article

Chen, N., Chen, X., Ding, X. et al. Analysis of the high incidence of acute kidney injury associated with acute-on-chronic liver failure. Hepatol Int 12, 262–268 (2018). https://doi.org/10.1007/s12072-018-9866-x

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  • DOI: https://doi.org/10.1007/s12072-018-9866-x

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