Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting
Mitra K. Nadim, John A. Kellum, Lui G. Forni, Claire Francoz, Sumeet K. Asrani, Marlies Ostermann, Andrew S. Allegretti, Javier A. Neyra, Jody C. Olson, Salvatore Piano, Lisa B. VanWagner, Elizabeth C. Verna, Ayse Akcan‐Arikan, Paolo Angeli, Justin M. Belcher, Scott W. Biggins, Akash Deep, Guadalupe García–Tsao, Yuri Genyk, Pere Ginès, Patrick S. Kamath, Sandra L. Kane‐Gill, Manish Kaushik, Nuttha Lumlertgul, Etienne Macedo, Rakhi Maiwall, Sebastián Marciano, Raimund Pichler, Claudio Ronco, Puneeta Tandon, Juan-Carlos Q. Velez, Ravindra L. Mehta, François Durand
Abstract
Patients with cirrhosis are prone to developing acute kidney injury (AKI), a complication associated with a markedly increased in-hospital morbidity and mortality, along with a risk of progression to chronic kidney disease. Whereas patients with cirrhosis are at increased risk of developing any phenotype of AKI, hepatorenal syndrome (HRS), a specific form of AKI (HRS-AKI) in patients with advanced cirrhosis and ascites, carries an especially high mortality risk. Early recognition of HRS-AKI is crucial since administration of splanchnic vasoconstrictors may reverse the AKI and serve as a bridge to liver transplantation, the only curative option. In 2023, a joint meeting of the International Club of Ascites (ICA) and the Acute Disease Quality Initiative (ADQI) was convened to develop new diagnostic criteria for HRS-AKI, to provide graded recommendations for the work-up, management and post-discharge follow-up of patients with cirrhosis and AKI, and to highlight priorities for further research.