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Hepatol Int. 2016 May;10(3):525-31. doi: 10.1007/s12072-016-9706-9. Epub 2016 Jan 29.

National trends of acute kidney injury requiring dialysis in decompensated cirrhosis hospitalizations in the United States.

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Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1243, New York, NY, 10029, USA.
Division of Gastroenterology and Nutrition, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1243, New York, NY, 10029, USA.
Division of Nephrology, Department of Medicine, University of Buffalo School of Medicine, Buffalo, NY, USA.
Division of Critical Care, Department of Medicine, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India.
Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.



Cirrhosis affects 5.5 million patients with estimated costs of US$4 billion. Previous studies about dialysis requiring acute kidney injury (AKI-D) in decompensated cirrhosis (DC) are from a single center/year. We aimed to describe national trends of incidence and impact of AKI-D in DC hospitalizations.


We extracted our cohort from the Nationwide Inpatient Sample (NIS) from 2006-2012. We identified hospitalizations with DC and AKI-D by validated ICD9 codes. We analyzed temporal changes in DC hospitalizations complicated by AKI-D and utilized multivariable logistic regression models to estimate AKI-D impact on hospital mortality.


We identified a total of 3,655,700 adult DC hospitalizations from 2006 to 2012 of which 78,015 (2.1 %) had AKI-D. The proportion with AKI-D increased from 1.5 % in 2006 to 2.23 % in 2012; it was stable between 2009 and 2012 despite an increase in absolute numbers from 6773 to 13,930. The overall hospital mortality was significantly higher in hospitalizations with AKI-D versus those without (40.87 vs. 6.96 %; p < 0.001). In an adjusted multivariable analysis, adjusted odds ratio for mortality was 2.17 (95 % CI 2.06-2.28; p < 0.01) with AKI-D, which was stable from 2006 to 2012. Changes in demographics and increases in acute/chronic comorbidities and procedures explained temporal changes in AKI-D.


Proportion of DC hospitalizations with AKI-D increased from 2006 to 2009, and although this was stable from 2009 to 2012, there was an increase in absolute cases. These results elucidate the burden of AKI-D on DC hospitalizations and excess associated mortality, as well as highlight the importance of prevention, early diagnosis and testing of novel interventions in this vulnerable population.


Acute kidney injury; Cirrhosis; Dialysis; Mortality

[Indexed for MEDLINE]

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