National trends of acute kidney injury requiring dialysis in decompensated cirrhosis hospitalizations in the United States

Hepatol Int. 2016 May;10(3):525-31. doi: 10.1007/s12072-016-9706-9. Epub 2016 Jan 29.


Background and aims: Cirrhosis affects 5.5 million patients with estimated costs of US$4 billion. Previous studies about dialysis requiring acute kidney injury (AKI-D) in decompensated cirrhosis (DC) are from a single center/year. We aimed to describe national trends of incidence and impact of AKI-D in DC hospitalizations.

Methods: We extracted our cohort from the Nationwide Inpatient Sample (NIS) from 2006-2012. We identified hospitalizations with DC and AKI-D by validated ICD9 codes. We analyzed temporal changes in DC hospitalizations complicated by AKI-D and utilized multivariable logistic regression models to estimate AKI-D impact on hospital mortality.

Results: We identified a total of 3,655,700 adult DC hospitalizations from 2006 to 2012 of which 78,015 (2.1 %) had AKI-D. The proportion with AKI-D increased from 1.5 % in 2006 to 2.23 % in 2012; it was stable between 2009 and 2012 despite an increase in absolute numbers from 6773 to 13,930. The overall hospital mortality was significantly higher in hospitalizations with AKI-D versus those without (40.87 vs. 6.96 %; p < 0.001). In an adjusted multivariable analysis, adjusted odds ratio for mortality was 2.17 (95 % CI 2.06-2.28; p < 0.01) with AKI-D, which was stable from 2006 to 2012. Changes in demographics and increases in acute/chronic comorbidities and procedures explained temporal changes in AKI-D.

Conclusions: Proportion of DC hospitalizations with AKI-D increased from 2006 to 2009, and although this was stable from 2009 to 2012, there was an increase in absolute cases. These results elucidate the burden of AKI-D on DC hospitalizations and excess associated mortality, as well as highlight the importance of prevention, early diagnosis and testing of novel interventions in this vulnerable population.

Keywords: Acute kidney injury; Cirrhosis; Dialysis; Mortality.

MeSH terms

  • Acute Kidney Injury / epidemiology*
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / mortality
  • Acute Kidney Injury / therapy
  • Adult
  • Aged
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / epidemiology*
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / therapy
  • Male
  • Middle Aged
  • Renal Dialysis / mortality
  • Renal Dialysis / statistics & numerical data*
  • United States / epidemiology
  • Young Adult