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Renal Replacement Therapy for Acute Kidney Injury in Severe Alcohol-Associated Hepatitis as a Bridge to Transplant or Recovery

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Abstract

Background

Acute kidney injury is seen in approximately 30% of patients with severe alcohol-associated hepatitis (AH) and is associated with increased mortality. Controversy exists surrounding initiation of renal replacement therapy (RRT) in these patients, as most are ineligible for early transplantation.

Aims

The primary aim was to identify predictors of survival and identify patients who may benefit from RRT as a bridge to transplant or recovery.

Methods

A retrospective multicenter cohort of adult patients with AH, who received RRT, was developed, including patients from two North American and one European liver transplant centers.

Results

Fifty-five patients were included. Survival was 26/55 (47.3%) at 30 days, 17/55 (30.9%) at 3 months, and 15/55 (27.2%) at 6 months. Of those who survived 6 months, 2/15 (13.3%) received simultaneous liver and kidney transplantation, 11/15 (73.3%) had spontaneous recovery of kidney function, and 2/15 (13.3%) remained on RRT. Of patients who survived at least 3 months, 8/17 (47%) completed addiction treatment. Predictors of mortality were pre-RRT MELD (OR 1.10, 1.02–1.19) and pre-RRT MELD-Na (OR 1.14, 1.03–1.27). Pre-RRT MELD-Na < 35 was associated with lower 6-month mortality (OR 0.23, 0.06 – 0.81). Of patients with pre-RRT MELD-Na < 35, 50% survived 6 months compared to 18% of patients with pre-RRT MELD-Na ≥ 35.

Conclusions

Although RRT has a limited role in patients with decompensated cirrhosis, ineligible for transplant, it may be used in select patients with AH. This may allow for spontaneous recovery with alcohol abstinence or completion of addiction treatment prior to transplant.

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Abbreviations

AKI:

Acute kidney injury

AH:

Alcohol-associated hepatitis

RRT:

Renal replacement therapy,

NIAAA:

National Institute of Alcohol Abuse and Alcoholism

HRS-AKI:

Hepatorenal syndrome-acute kidney injury

MELD:

Model for End-Stage Liver Disease

MELD-Na:

Model for End-Stage Liver Disease-Sodium

SD:

Standard deviation

OR:

Odds ratio

CI:

Confidence interval

ATN:

Acute tubular necrosis

HE:

Hepatic encephalopathy

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Funding

There was no financial support. There were no grants to report.

Author information

Authors and Affiliations

  1. Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Brian E. Jones & Douglas A. Simonetto

  2. Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Andrew S. Allegretti

  3. Liver Unit, Hospital Clínic, University of Barcelona, Villarroel, 170, 08036, Barcelona, Catalonia, Spain

    Elisa Pose, Emma Avitabile & Pere Ginès

  4. Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Kristin C. Mara

  5. Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Nneka N. Ufere

  6. Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Vijay H. Shah & Patrick S. Kamath

Authors
  1. Brian E. Jones
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  2. Andrew S. Allegretti
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  10. Douglas A. Simonetto
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Correspondence to Douglas A. Simonetto.

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Conflict of interest

A.A. has served on the advisory board for Mallinckrodt Pharmaceutics. V.S. serves on the Advisory Board for Akaza Bioscience Ltd., Generon Shanghai, and Surrozen; he provides consulting services for Ambys Medicines and Durect Corporation. The other authors declare that there are no conflicts of interest.

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Appendix

Appendix

See Table 4

Table 4 Receiver Operating Characteristic Curve Input for Pre-Renal Replacement Therapy MELD-Na
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Jones, B.E., Allegretti, A.S., Pose, E. et al. Renal Replacement Therapy for Acute Kidney Injury in Severe Alcohol-Associated Hepatitis as a Bridge to Transplant or Recovery. Dig Dis Sci 67, 697–707 (2022). https://doi.org/10.1007/s10620-021-06864-z

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