Author(s): Fidalgo, Pedro ; Povoa, Pedro ; Germano, Nuno ; Karvellas, Constantine J. ; Cardoso, Filipe S.
Date: 2024
Persistent ID: http://hdl.handle.net/10362/163820
Origin: Repositório Institucional da UNL
Subject(s): Chronic kidney disease; Liver failure; Renal insufficiency; Gastroenterology
Publisher Copyright: © 2024 American Medical Association. All rights reserved.
Introduction: Acute liver failure (ALF) is a rare disease with high mortality. Acute kidney injury (AKI) following ALF is frequent. We assessed AKI impact on long-term kidney function among ALF survivors. Methods: Observational cohort study including consecutive adult (age ≥16 years) patients with ALF or acute liver injury (ALI) admitted to a Portuguese tertiary center intensive care unit (ICU) between October 2013 and February 2020. KDIGO criteria were used to define AKI and chronic kidney disease (CKD). Primary outcome was the estimated glomerular filtration rate (eGFR), defined by the Chronic Kidney Disease Epidemiology Collaboration formula, at least 1 year after index ICU admission. Results: Among 104 patients with ALF (n = 74) or ALI (n = 30), mean (SD) age was 43.7 (18.0) years, and 44 were male. Among all patients (n = 104), following adjustment for age and SOFA score, AKI during the first 7 ICU days (n AKI = 57 and n renal replacement therapy [RRT] = 32) was independently associated with all-cause mortality (adjusted HR [95% CI] 11.61 [1.49-90.34]; p = 0.019). Among hospital survivors with long-term kidney function available (n = 56), median (interquartile range) >1 year eGFR was 95.3 (75.0-107.7) mL/min/1.73 m2 (mean [SD] follow-up of 3.1 [1.6] years). Among these hospital survivors, following adjustment for baseline eGFR, AKI during the first 7 ICU days (n AKI = 19 and n RRT = 10) was not associated with >1 year eGFR (p = 0.15). At least 1 year after index ICU admission, 5 patients developed CKD, none RRT-dependent. Conclusions: Among ALF or ALI survivors, AKI was not associated with significant long-term loss of kidney function.
