Renal Recovery and Mortality Risk among Patients with Hepatorenal Syndrome Receiving Chronic Maintenance Dialysis. Issue 5 (27th May 2021)

• Record Type: Journal Article
• Authors: McAllister, Sophie; Lai, Jennifer C.; Copeland, Timothy P.; Johansen, Kirsten L.; McCulloch, Charles E.; Kwong, Yuenting D.; Seth, Divya; Grimes, Barbara; Ku, Elaine
• Is Part Of: Kidney360. Volume 2:Issue 5(2021)
• Page Start: 819
• Page End: 827
• Publication Date: 2021-05-27
• Subjects: dialysis -- acute tubular necrosis -- end stage kidney disease -- hemodialysis -- hepatorenal syndrome -- renal failure -- renal replacement therapy -- United States Renal Data System; 616.61
• DOI: 10.34067/KID.0005182020
• Languages: English
• ISSNs: 2641-7650

Abstract

Visual Abstract: Abstract : Key Points: Patients with hepatorenal syndrome (HRS) receiving maintenance dialysis have a lower likelihood of recovery of kidney function compared with patients with acute tubular necrosis (ATN). Patients with HRS receiving maintenance dialysis have a higher likelihood of mortality compared with patients with ATN. Younger age, history of alcohol use, and absence of comorbidities were predictors of recovery of kidney function in patients with HRS receiving maintenance dialysis. Background: Kidney replacement therapy is controversial for patients with hepatorenal syndrome who may not be liver transplant candidates. Data surrounding the likelihood of recovery of kidney function and mortality after outpatient dialysis initiation in patients with dialysis-requiring hepatorenal syndrome could inform discussions between patients and providers. Methods: We performed a retrospective cohort study of patients with hepatorenal syndrome who were registered in the United States Renal Data System between 1996 and 2015 ( n =7830) as receiving maintenance dialysis. We characterized patients with hepatorenal syndrome by recovery of kidney function using Fine and Gray models. We also examined hazard of recovery of kidney function and death among those with hepatorenal syndrome versus those with acute tubular necrosis ( n =48, 861) using adjusted Fine–Gray and Cox models, respectively. Results: Of the patients with hepatorenal syndrome, 11% recovered kidney function. Those with higher likelihood of recovery were younger, non-Hispanic White, and had a history of alcohol use. Compared with patients with acute tubular necrosis, patients with hepatorenal syndrome as the attributed cause of kidney disease had a lower hazard of recovery (HR, 0.22; 95% CI, 0.21 to 0.24) and higher hazard of death within 1 year (HR, 3.10; 95% CI, 2.99 to 3.23) in fully adjusted models. Conclusions: Patients with hepatorenal syndrome receiving chronic maintenance dialysis had a lower likelihood of recovery of kidney function and higher mortality risk compared with patients with acute tubular necrosis. Among patients with hepatorenal syndrome, those most likely to recover kidney function were younger, had a history of alcohol use, and lacked comorbid conditions. These data may inform prognosis and discussions surrounding treatment options when patients with hepatorenal syndrome need chronic maintenance dialysis therapy.