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Transient and persistent acute kidney injury in acute liver failure

  • Silvia CoelhoEmail author
  • José Nuno Fonseca
  • Joana Gameiro
  • Sofia Jorge
  • José Velosa
  • José António Lopes
Original Article
  • 35 Downloads

Abstract

Background

Acute Kidney Injury (AKI) is a very frequent complication in the Acute Liver Failure (ALF) population associated with negative outcomes. We aim to evaluate the impact of AKI duration on the outcomes of an ALF population.

Methods

A 20-year retrospective analysis of ALF patients admitted to an Intensive Care Unit (ICU) was performed. Chronic liver failure, chronic kidney disease on renal replacement therapy, dialysis requirement within the week prior or an ICU stay of less than 48 h after AKI diagnosis, were exclusion criteria. AKI was defined according to the KDIGO criteria and classified into transient (< 48 h duration) or persistent (48 h duration).

Results

A total of 51 patients were included in the analysis and most had AKI (66.7%). Persistent AKI patients (70.6%) presented more frequently with AKI at admission and a higher SOFA score than transient AKI and no AKI, p < 0.05. More severe AKI, sepsis, vasopressor support and mechanical ventilation were also more common (p < 0.05). Nineteen (55.9%) were classified as persistent AKI exclusively by serum creatinine and 15 (44.1%) by both serum creatinine and urine output criteria. Mean survival time at 30 days was 11.3 days for persistent AKI, 25.3 days for transient AKI and 27.0 days for no AKI, p = 0.01. Adjusted multivariate cox regression analysis showed that persistent AKI predicted in-hospital mortality but it lost significance when AKI severity was introduced in the model.

Conclusion

Persistent AKI was common in ALF patients and associated with more severe AKI, worst systemic complications and a higher 30-day mortality, compared to transient and no AKI patients.

Keywords

Acute kidney injury Persistent AKI Transient AKI Acute liver failure 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

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Copyright information

© Italian Society of Nephrology 2018

Authors and Affiliations

  1. 1.Intensive Care DepartmentHospital Fernando Fonseca, EPEAmadoraPortugal
  2. 2.CEDOC, Chronic Diseases Research Center, NOVA Medical SchoolNOVA University of LisbonLisbonPortugal
  3. 3.Division of Nephrology and Renal Transplantation, Department of MedicinaCentro Hospitalar Lisboa Norte, EPELisboaPortugal
  4. 4.Gastrenterology and Hepatology Intensive Care UnitCentro Hospitalar Lisboa Norte, EPELisboaPortugal

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