Risk and protective factors of acute kidney injury in decompensated cirrhotic patients with ascites on tolvaptan. Issue 11 (1st November 2021)

• Record Type: Journal Article
• Authors: Kogiso, Tomomi; Ogasawara, Yuri; Sagawa, Takaomi; Taniai, Makiko; Tokushige, Katsutoshi
• Is Part Of: JGH open. Volume 5:Issue 11(2021)
• Page Start: 1298
• Page End: 1305
• Publication Date: 2021-11-01
• Subjects: acute kidney injury -- kanamycin/rifaximin -- liver cirrhosis -- proton pump inhibitor/H2 blockers -- tolvaptan
• DOI: 10.1002/jgh3.12672
• Languages: English
• ISSNs: 2397-9070

Abstract

Abstract: Background and Aim: Acute kidney injury (AKI) is a life‐threatening complication of liver cirrhosis. Here, we evaluated the risk factors and characteristics of AKI in cirrhosis. Patients/Methods: This was a single‐center retrospective study. A total of 199 Japanese patients with decompensated liver cirrhosis (104 men, median age 61 years) were enrolled and received tolvaptan orally. Survival rates and new onset of AKI were monitored, and risk factors were evaluated. Results: Forty‐six patients (23.1%) suffered an AKI complication and exhibited significantly poorer survival ( P < 0.01). The rates of hepatic encephalopathy ( P < 0.01) and chronic kidney disease (CKD; P = 0.02) were significantly increased in patients with AKI. The rate of proton pump inhibitor (PPI)/H2 blocker treatment ( P = 0.04) was significantly lower, whereas that of ascites drainage was significantly higher in the AKI cases ( P < 0.01). The AKI risk was significantly increased in patients with hepatic encephalopathy (HR 4.18, 95% CI 1.618–10.771). In contrast, the incidence of AKI was significantly lower in patients with a higher serum albumin level (HR 0.36, 95% CI 0.142–0.914, P = 0.03). Treatment with PPI/H2 blockers (HR 0.30, 95% CI 0.126–0.711, P < 0.01) or kanamycin/rifaximin (HR 0.26, 95% CI 0.075–0.929, P = 0.04) was significantly associated with a reduced risk of AKI development. Conclusions: AKI incidence was increased in patients with decreased liver function and was associated with poor survival. PPI/H2 blocker or kanamycin/rifaximin treatment may reduce the risk of AKI. Abstract : In cirrhosis, AKI incidence was increased in patients with encephalopathy and poor liver function. While proton pump inhibitor/H2 blocker or kanamycin/rifaximin treatment may reduce the risk of AKI.