Relevance of New Definitions to Incidence and Prognosis of Acute Kidney Injury in Hospitalized Patients with Cirrhosis: A Retrospective Population-Based Cohort Study

BackgroundThe implementation of new serum creatinine (SCr)-based criteria for acute kidney injury (AKI) has brought to light several areas of uncertainty in patients with cirrhosis.Study DesignPopulation-based cohort study.Setting & ParticipantsAdults with cirrhosis hospitalized between 2002–2012.PredictorWe aimed to address the prognostic implications of the new AKI criteria in cirrhosis.OutcomesBaseline kidney function was defined from all outpatient SCr within 3 months before hospitalization. Cox proportional hazards models were fit to examine associations between AKI, renal recovery and all-cause mortality.Results4,733 patients were studied. The 30-day mortality was higher for participants with AKI (43.9% vs 8.5%; p-valueLimitationsAs an observational study, the results were vulnerable to residual confounding and ascertainment bias in the use of laboratory data to identify AKI. We did not have access to liver function or disease etiology variables and were unable to adjust for these in our analyses.ConclusionsThese results confirm the graded relationship between AKI severity, renal recovery, and mortality and further clarify previously discordant reports about the prognostic relevance of new AKI criteria in patients with cirrhosis.