APASL clinical practice guidelines on the management of acute kidney injury in acute-on-chronic liver failure

Maiwall R 1 , Singh SP 1 , Angeli P 2 , Moreau R 3 , Krag A 4 , Singh V 5 Show all authors , Singal AK 6 , Tan SS 7 , Puri P 8 , Mahtab M 9 , Lau G 10 , Ning Q 11 , Sharma MK 1 , Rao PN 12 , Kapoor D 13 , Gupta S 14 , Duseja A 15 , Wadhawan M 16 , Jothimani D 17 , Saigal S 18 , Taneja S 15 , Shukla A 19 , Puri P 20 , Govil D 21 , Pandey G 22 , Madan K 18 , Eapen CE 23 , Benjamin J 24 , Chowdhury A 1 , Singh S 25 , Salao V 26 , Yang JM 27 , Hamid S 28 , Shalimar 29 , Jasuja S 30 , Kulkarni AV 31 , Niriella MA 32 , Tevethia HV 1 , Arora V 1 , Mathur RP 33 , Roy A 34 , Jindal A 1 , Saraf N 35 , Verma N 15 , De A 15 , Choudhary NS 36 , Mehtani R 19 , Chand P 1 , Rudra O 1 , Sarin SK 37

Affiliations 

  • 1 Department of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
  • 2 Department of Internal Medicine and Hepatology, University of Padova, Padua, Italy
  • 3 European Foundation for the Study of Chronic Liver Failure (EF CLIF), European Association for the Study of the Liver (EASL)-CLIF Consortium, and Grifols Chair, Barcelona, Spain
  • 4 Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
  • 5 Punjab Institute of Liver and Biliary Sciences, Mohali, Punjab, India
  • 6 Department of Medicine, University of Louisville School of Medicine, Trager Transplant Center and Jewish Hospital, Louisville, USA
  • 7 Department of Medicine, Hospital Selayang, Bata Caves, Selangor, Malaysia
  • 8 Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
  • 9 Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 10 Humanity and Health Medical Group, Humanity and Health Clinical Trial Center, Hong Kong SAR, China
  • 11 Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 12 Department of Hepatology and Nutrition, Asian Institute of Gastroenterology, Hyderabad, India
  • 13 Department of Hepatology, Gleneagles Global Hospitals, Hyderabad, Telangana, India
  • 14 Department of Surgery, Center for Liver and Biliary Sciences, Max Healthcare, Saket, New Delhi, India
  • 15 Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
  • 16 Institute of Digestive & Liver Diseases, BLK Superspeciality Hospital Delhi, New Delhi, India
  • 17 Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India
  • 18 Department of Gastroenterology and Hepatology, Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, India
  • 19 Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
  • 20 Fortis Escorts Liver & Digestive Diseases Institute, New Delhi, India
  • 21 Department of Critical Care and Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
  • 22 Gastroenterology and Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  • 23 Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India
  • 24 Department of Clinical Nutrition, Institute of Liver and Biliary Sciences, New Delhi, India
  • 25 Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, India
  • 26 Department of Critical Care, Fortis Hospital, Mulund, Mumbai, India
  • 27 Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
  • 28 Department of Hepatology, Aga Khan University, Karachi, Pakistan
  • 29 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
  • 30 Department of Nephrology, Indraprastha Apollo Hospitals, New Delhi, India
  • 31 Deparment of Hepatology, AIG Hospitals, Hyderabad, India
  • 32 Department of Medicine, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
  • 33 Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India
  • 34 Department of Gastroenterology, Institute of Gastrosciences and Liver Transplantation, Apollo Hospitals, Kolkata, India
  • 35 Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Delhi (NCR), India
  • 36 Department of Hepatology and Liver Transplantation, Medanta-The Medicity Hospital, Gurugram, Haryana, India
  • 37 Department of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India. sksarin@ilbs.in
Hepatol Int, 2024 Jun;18(3):833-869.
PMID: 38578541 DOI: 10.1007/s12072-024-10650-0

Abstract

Acute-on-chronic liver failure (ACLF) is a syndrome that is characterized by the rapid development of organ failures predisposing these patients to a high risk of short-term early death. The main causes of organ failure in these patients are bacterial infections and systemic inflammation, both of which can be severe. For the majority of these patients, a prompt liver transplant is still the only effective course of treatment. Kidneys are one of the most frequent extrahepatic organs that are affected in patients with ACLF, since acute kidney injury (AKI) is reported in 22.8-34% of patients with ACLF. Approach and management of kidney injury could improve overall outcomes in these patients. Importantly, patients with ACLF more frequently have stage 3 AKI with a low rate of response to the current treatment modalities. The objective of the present position paper is to critically review and analyze the published data on AKI in ACLF, evolve a consensus, and provide recommendations for early diagnosis, pathophysiology, prevention, and management of AKI in patients with ACLF. In the absence of direct evidence, we propose expert opinions for guidance in managing AKI in this very challenging group of patients and focus on areas of future research. This consensus will be of major importance to all hepatologists, liver transplant surgeons, and intensivists across the globe.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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