Natural history of acute kidney disease in patients with cirrhosis.

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In 2012, KDIGO group proposed new definitions for Acute Kidney Injury (AKI), Acute Kidney Disease (AKD) and Chronic Kidney Disease (CKD). According to the definition adapted by the International Club of Ascites (ICA), AKI has been extensively investigated in patients with cirrhosis. On the contrary, there are currently no data on the epidemiology and clinical outcome of AKD in these patients. The aim of the study was to assess the prevalence and the impact of AKD on the clinical course and survival in patients with cirrhosis.272 consecutive patients with cirrhosis attending our outpatient clinic were included in the study. Clinical and laboratory data were collected at inclusion in the study. Patients were followed up until death, liver transplant or the end of follow up.During follow up, 80 patients developed AKD (29.4%). Forty-two (52.5%) recovered from the first episode of AKD and 26 maintained a normal renal function up to the end of the follow up. Sixteen patients developed a second episode of AKD. Globally, 36 patients (45.0%) died while on AKD. Finally in 11 patients (13.8%) AKD progressed to CKD. The 5-year survival was significantly lower in patients who developed AKD than in those who didn't (34.8% versus 88.8%, p<0.001). The 5-year rate of complications of cirrhosis and that of hospitalizations were also higher in patients with AKD than in those without AKD.AKD is frequent in patients with cirrhosis. It can be a reversible process but it may recur and also progress to CKD. AKD has a very negative impact on morbidity and mortality in patients with cirrhosis.

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