Incidence and risk factors of acute kidney injury in cirrhosis: a systematic review and meta-analysis of 5,202,232 outpatients, inpatients and ICU-admitted patients

ABSTRACT

Introduction

Acute kidney injury (AKI) is a commonly seen condition in the natural course of cirrhosis. The aim of this study was to evaluate the pooled incidence and risk factors of AKI in different clinical stages and situations in patients with cirrhosis.

Methods

Search was conducted on 13 December 2023 across MEDLINE (PubMed), Embase, and Cochrane databases. Meta-analysis was performed using a generalized linear mixed model.

Results

In total, 73 studies with 5,202,232 patients were finally enrolled in the meta-analysis. AKI commonly occurs among hospitalized cirrhotics experiencing any decompensation event (29%) as well as among stable outpatients (28%) throughout a 1-year follow-up period. On admission, patients with infection or sepsis/septic shock had the highest AKI rate (47%), followed by those with hepatic encephalopathy (41%). Furthermore, the severity of liver disease proved to be a substantial driver for AKI development, while patients at intensive care unit had the greatest AKI incidence (61%).

Conclusions

Both hospitalized patients and stable outpatients with cirrhosis exhibited an elevated susceptibility to AKI. Patients at intensive care unit and those with severe liver disease, infection, sepsis/septic shock, hepatic encephalopathy or acute on chronic liver failure upon admission are at higher risk for AKI.

KEYWORDS:

• Cirrhosis
• acute kidney injury
• infection
• sepsis
• hepatic encephalopathy
• intensive care unit
• acute on chronic liver failure

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethical guidelines statement

The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The manuscript does not contain clinical studies or patient data.

Data availability

The datasets generated and analyzed during the current study are available upon request.

Trial registration

PROSPERO, registered 09/12/23, CRD42023487736

Abbreviations

AKI: Acute Kidney Injury; AKIN: Acute Kidney Injury Network; ADQI: Acute Dialysis Quality Initiative; HRS: Hepatorenal Syndrome; ICA: International Club of Ascites; KDIGO: Kidney Disease: Improving Global Outcomes; ICD-10: International Classification of Diseases, 10th edition; NAFLD: Non-Alcoholic Fatty Liver Disease; ALD: Alcoholic Liver Disease; CTP: Child-Turcotte-Pugh; MELD: Model for End-Stage Liver Disease; GI: Gastrointestinal; ICU: Intensive Care Unit; ACLF: Acute on Chronic Liver Failure; GFR: Glomerular Filtration Rate; RIFLE: Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease; SIRS: Systemic Inflammatory Response Syndrome

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17474124.2024.2380299

Additional information

Funding

This paper was not funded.