Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting.
A joint ADQI and International Club of Ascites consensus updated the diagnostic criteria and management recommendations for acute kidney injury in cirrhosis, with particular emphasis on early recognition of hepatorenal syndrome-AKI.
Background
Patients with cirrhosis are prone to developing acute kidney injury, a complication associated with markedly increased in-hospital morbidity and mortality and a risk of progression to chronic kidney disease. Hepatorenal syndrome, a specific form of AKI in patients with advanced cirrhosis and ascites, carries an especially high mortality risk.
Key recommendations
In 2023 a joint meeting of the International Club of Ascites and the Acute Disease Quality Initiative was convened to develop new diagnostic criteria for hepatorenal syndrome-AKI and to provide graded recommendations for the work-up, management, and post-discharge follow-up of patients with cirrhosis and AKI. The consensus emphasizes that early recognition of hepatorenal syndrome-AKI is crucial, since administration of splanchnic vasoconstrictors may reverse the injury and serve as a bridge to liver transplantation, the only curative option.
Clinical implications
The statement standardizes the approach to diagnosis and treatment of AKI in cirrhosis and highlights priorities for further research. By refining criteria for early detection and prompt vasoconstrictor therapy, it aims to improve outcomes in a population where renal impairment strongly predicts mortality.
Category
Guidelines
Source
J Hepatol
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