Hepatorenal syndrome-acute kidney injury patient characteristics, treatment, and clinical response by disease severity in us: Real-world practice patterns from 11 us hospitals

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Conference Proceeding

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Background: Hepatorenal syndrome-acute kidney injury (HRS-AKI) is characterized by rapid deterioration in renal function in cirrhotic patients. Previous studies have shown that vasoconstrictors improve outcomes for HRS patients and found disease severity to be an important determinant of patient response. This study aims to describe characteristics of HRS-AKI patients in United States and assess real-world outcomes based on disease severity. Methods: This was a retrospective chart review study of adults (≥18 years) hospitalized at 11 tertiary care centers for a first HRS-AKI episode, identified by ICD-10 codes and/or the investigator's clinical judgment, between January 1, 2016 and June 30, 2019. The primary outcome was HRS response, defined as complete response (CR; serum creatinine [SCr] improved to ≤1.5 mg/dL), partial response (PR; ≥30% decrease in SCr to >1.5 mg/dL) and no response (<30% decrease in SCr). Patients were classified as standard presentation (baseline SCr<5 mg/dL, acute-on-chronic liver failure (ACLF) grade 0-2, and Model for End-stage Liver Disease (MELD) score <35) and severe presentation (baseline SCr≥5 mg/dL or ACLF >2 or MELD score ≥35). Results: A total of 132 (65 in the standard group and 67 in the severe group) were included in the analysis. Of these, 54.5% were male, mean age was 57 years, and 68.2% were White. The most common precipitating events were treatment with diuretics (42.4%) and large-volume paracentesis (41.7%); gastrointestinal bleeding was less common in the standard group compared to the severe group (7.7% vs. 31.3%, p<0.001). The most common underlying causes of cirrhosis were alcohol use (55.3%) and NASH/NAFLD (16.7%). Initial vasopressor therapies were similar between the two groups (midodrine/octreotide [89.2% in standard presentation vs. 82.1% in severe presentation], norepinephrine [1.5% vs. 6.0%], and other [9.2% vs. 11.9%]; p=0.365). The median duration of initial therapy (in days) was: midodrine/octreotide (5 vs. 6, p>0.05), norepinephrine (3 vs. 6.5, p>0.05), other therapy (12 vs. 5.5, p<0.05). More than 99% of patients received concomitant albumin. Overall, response to therapy was low (CR: 13.8% vs. 17.9% or PR: 9.2% vs. 16.4% in the standard and severe groups, respectively, p=0.3, Figure). Conclusion: Midodrine/octreotide was the most widely used vasopressor for HRS-AKI, and response rate was low.

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