Acute kidney injury in decompensated cirrhosis

Gut. 2013 Jan;62(1):131-7. doi: 10.1136/gutjnl-2011-301255. Epub 2012 May 25.


Background: Hepatorenal syndrome in cirrhosis with ascites is a well-defined entity with significant morbidity and mortality. It is unclear whether milder degrees of acute kidney injury (AKI), defined as a serum creatinine increase of over 26.4 μmol/l (0.3 mg/dl) or by 50% from baseline, also has a negative impact on patient outcomes.

Objectives: To determine the prevalence of AKI in cirrhosis with ascites and the impact of AKI on patient outcomes.

Design: Patients with cirrhosis with ascites and baseline serum creatinine less than 110 μmol/l, and no evidence of structural renal disease, prospectively underwent 4-6-weekly blood work-up for full blood count, biochemistry and liver function. Clinical assessments occurred every 4 months for the development of AKI and other complications.

Results: 90 patients (mean age 55.8 ± 0.8 years) with a mean follow-up of 14.05 ± 1.07 months were enrolled. 82 episodes of AKI occurred in 49 patients, with the majority of episodes precipitated by a disturbance in systemic haemodynamics. The mean peak serum creatinine of the AKI episodes was within the laboratory's normal range. 73 episodes of AKI resolved; nine did not. There was no clear clinical predictor for the development or resolution of AKI. Despite resolution of most AKI episodes, a gradual and significant increase in serum creatinine and a gradual reduction in mean arterial pressure were observed during follow-up, associated with a significant reduction in survival compared with non-AKI patients.

Conclusion: Minor increases in serum creatinine are clinically relevant and can adversely affect survival. Every effort should be made to avoid precipitation of AKI in cirrhosis and ascites.

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / etiology*
  • Adolescent
  • Adult
  • Aged
  • Ascites / etiology
  • Biomarkers / blood
  • Creatinine / blood
  • Female
  • Follow-Up Studies
  • Hepatorenal Syndrome / etiology
  • Humans
  • Kaplan-Meier Estimate
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / mortality
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Prospective Studies
  • Young Adult


  • Biomarkers
  • Creatinine