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Chances of Renal Recovery or Liver Transplantation After Hospitalization for Alcoholic Liver Disease Requiring Dialysis

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Abstract

Background

Acute kidney injury in the setting of alcoholic liver disease portends a poor prognosis without liver transplant.

Aims

Using a tertiary care population, we aimed to evaluate the outcomes of renal replacement therapy in patients with alcoholic liver disease and acute kidney injury with < 6 months sobriety.

Methods

A retrospective review of hospitalized patients with alcoholic hepatitis/acute on chronic alcoholic cirrhosis and hepatorenal syndrome or acute tubular necrosis was performed. Analyzed variables included patient comorbidities, mode of dialysis, MELD-Na score, CLIF-C ACLF score, and CLIF-C OF score.

Results

Forty-seven patients were included, 21.3% of which survived 6 months of sobriety to be eligible for transplant evaluation. Despite renal replacement therapy, mortality was 78.7%. Of survivors, 4 received transplants and 6 recovered without transplant. Lower CLIF-C ACLF (p < 0.001) and CLIF-C OF (p = 0.001) predicted 6-month survival and lower MELD-Na (p = 0.016), CLIF-C ACLF (p < 0.001), and CLIF-C OF (p = 0.006) predicted renal recovery. There was no difference in survival or renal recovery between etiologies of kidney injury. Modality of initial dialysis with intermittent hemodialysis compared to continuous renal replacement therapy predicted improved survival (41.2 vs. 10.0%, p = 0.01) and nearly reached significance for renal recovery (23.5 vs. 6.7%, p = 0.054).

Conclusions

Although severe alcoholic liver disease with acute kidney injury is associated with a high mortality irrespective of the etiology of renal failure, over 20% of patients in this study survived 6 months to be evaluated for liver transplant and 12.8% recovered renal function. These outcomes should be considered when weighing the decision of initiating dialysis.

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Abbreviations

AKI:

Acute kidney injury

ALD:

Alcoholic liver disease

LT:

Liver transplant

MDF:

Maddrey discriminant function

MELD:

Model for end-stage liver disease

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Authors and Affiliations

  1. Department of Internal Medicine, Henry Ford Health System, Henry Ford Hospital, Detroit, MI, 48202, USA

    Adrienne Lenhart

  2. Division of Gastroenterology and Hepatology, Henry Ford Hospital, 2799 W Grand Blvd., Detroit, MI, 48202, USA

    Salwa Hussain & Reena Salgia

Authors
  1. Adrienne Lenhart
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  2. Salwa Hussain
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  3. Reena Salgia
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Correspondence to Adrienne Lenhart.

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No conflicts of interest and no writing assistance were utilized.

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Lenhart, A., Hussain, S. & Salgia, R. Chances of Renal Recovery or Liver Transplantation After Hospitalization for Alcoholic Liver Disease Requiring Dialysis. Dig Dis Sci 63, 2800–2809 (2018). https://doi.org/10.1007/s10620-018-5170-9

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  • DOI: https://doi.org/10.1007/s10620-018-5170-9

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