Applying Metabolomics and Aptamer-Based Proteomics to Determine Pathophysiologic Differences in Decompensated Cirrhosis Patients Hospitalized with Acute Kidney Injury.

Introduction: Limited understanding of kidney dysfunction types and acute kidney injury (AKI) recovery exists due to biopsy risks in decompensated cirrhosis patients. To inform this, we analyzed aptamer-based proteomics and metabolomics to differentiate by AKI diagnosis and recovery.

Methods: A case-control study of 97 patients hospitalized at our institution.

Ambulatory Acute Kidney Injury in Patients With Cirrhosis Is Common and Burdensome.

Background & Aims: Little is known about ambulatory acute kidney injury (A-AKI), which develops in an outpatient setting.

Methods: We conducted a retrospective cohort study of patients diagnosed with cirrhosis between January 1, 2018, and December 31, 2019 from 130 hospitals in the Veterans Affairs healthcare system. Patients were classified as having incident A-AKI if they met the International Club of Ascites AKI criteria in an outpatient setting.

Patterns of dietary supplement use among United States patients with steatotic liver disease: Vitamins, minerals and botanicals.

Background: Dietary supplement (DS) usage among United States adults has significantly increased. Patients with steatotic liver disease (SLD) may have unique motivations to take DS in light of their liver condition and co-morbidities.

Aim: To characterize DS use in SLD patients and explore motivations for their use.

The relationship between mean arterial pressure and terlipressin in hepatorenal syndrome-acute kidney injury reversal: A post hoc analysis.

Background And Aims: Terlipressin reverses hepatorenal syndrome-acute kidney injury (HRS-AKI) by increasing mean arterial pressure (MAP). To further characterize the relationship between terlipressin and MAP and their impact on HRS-AKI reversal, we used patient-level data from phase 3 clinical trials REVERSE and CONFIRM.

Approach And Results: In this post hoc analysis we employed a linear mixed-effects model to assess terlipressin's impact on MAP, exploring the relationship between MAP, treatment group, and time, incorporating a random intercept for individual patients.

Acute Kidney Injury in Patients With Cirrhosis and Chronic Kidney Disease: Results From the HRS-HARMONY Consortium.

Background & Aims: Chronic kidney disease (CKD) frequency is increasing in patients with cirrhosis and these individuals often experience acute kidney injury (AKI). Direct comparisons of outcomes between AKI-only versus AKI on CKD (AoCKD) among patients with cirrhosis are not well described.

Methods: A total of 2057 patients with cirrhosis and AKI across 11 hospital networks from the HRS-HARMONY consortium were analyzed (70% AKI-only and 30% AoCKD).

Clinical Sentiment Analysis by Large Language Models Enhances the Prediction of Hepatorenal Syndrome in Decompensated Cirrhosis.

Background And Aims: Hepatorenal syndrome - Acute Kidney Injury (HRS-AKI) is a severe complication of decompensated cirrhosis that is challenging to predict. Sentiment analysis, a computational process of identifying and categorizing opinions and judgment expressed in text, may enhance traditional prediction methodologies based on structured variables. Large language models (LLMs), such as generative pretrained transformers (GPTs), have demonstrated abilities to perform sentiment analyses on non-clinical texts.

Investigating the Association between Steatotic Liver Disease and CKD in a Nationally Representative Sample.

Key Points: CKD is more common among those with steatotic liver disease compared with those without liver disease in the United States. Higher degrees of liver fibrosis are associated with greater prevalence of CKD independent of other common risk factors of kidney disease.

Background: Steatotic liver disease (SLD) and CKD are common conditions that are strongly associated.

Impact of acute kidney injury response on survival and liver transplant rates in hospitalized patients with cirrhosis awaiting liver transplantation: Results from the HRS-HARMONY consortium.

Acute kidney injury (AKI) frequently complicates the course of hospitalized patients with cirrhosis and negatively affects their prognosis. How AKI response influences the timing of liver transplantation (LT) remains unclear. We sought to assess the impact of AKI response to treatment on survival and LT rates in patients with cirrhosis awaiting LT.

Outcomes of patients with alcohol-associated hepatitis and acute kidney injury - Results from the HRS Harmony Consortium.

Background & Aims: The development of acute kidney injury (AKI) in the setting of alcohol-associated hepatitis (AH) portends a poor prognosis. Whether the presence of AH itself drives worse outcomes in patients with cirrhosis and AKI is unknown.

Methods: Retrospective cohort study of 11 hospital networks of consecutive adult patients admitted in 2019 with cirrhosis and AKI.

The type, duration, and severity of pretransplant kidney injury predict prolonged kidney dysfunction after liver transplantation.

Chronic kidney disease (CKD) is a major complication of liver transplantation (LT) associated with substantial morbidity and mortality. Knowing the drivers of post-LT kidney dysfunction-with a granular focus on the type, duration, and severity of pre-LT kidney disease-can highlight intervention opportunities and inform dual-organ allocation policies. We retrospectively analyzed predictors of safety net kidney after liver transplant (KALT) eligibility and kidney replacement therapy (KRT) for > 14 days after LT.

Performance of race-neutral eGFR equations in patients with decompensated cirrhosis.

The 2021 Chronic Kidney Disease Epidemiology Collaboration equation [CKD-EPI 2021] is a race-neutral equation recently developed and rapidly implemented as a reference standard to estimate glomerular filtration rate(GFR). However, its role in cirrhosis has not been examined especially in low GFR. We analyzed the performance of CKD-EPI 2021 compared to other equations with protocol-measured GFR (mGFR) in cirrhosis.

Applying Metabolomics and Aptamer-based Proteomics to Determine Pathophysiologic Differences in Decompensated Cirrhosis Patients Hospitalized with Acute Kidney Injury.

A case-control study of 97 patients hospitalized at our institution. We performed aptamer-based proteomics and metabolomics on serum biospecimens obtained within 72 hours of admission. We compared the proteome and metabolome by the AKI phenotype (i.

The association between mean arterial pressure and acute kidney injury reversal among patients with decompensated cirrhosis.

Background And Aims: This study informs how mean arterial pressure (MAP) impacts acute kidney injury (AKI) recovery among all patients hospitalized with cirrhosis, regardless of etiology.

Approach And Results: We identified incident AKI episodes among subjects in our cohort of patients with decompensated cirrhosis. AKI was defined as a ≥50% increase in creatinine from an outpatient baseline (≥7 days prior) that required hospitalization.

Outpatient mean arterial pressure: A potentially modifiable risk for acute kidney injury and death among patients with cirrhosis.

Mean arterial blood pressure (MAP), which decreases as portal hypertension progresses, may be a modifiable risk factor among patients with cirrhosis. We included adults enrolled in the Functional Assessment in Liver Transplantation study. We completed latent class trajectory analyses to define MAP trajectories.

From past to present to future: Terlipressin and hepatorenal syndrome-acute kidney injury.

Hepatorenal syndrome (HRS) is a rare and highly morbid form of kidney injury unique to patients with decompensated cirrhosis. HRS is a physiologic consequence of portal hypertension, leading to a functional kidney injury that can be reversed by restoring effective circulating volume and renal perfusion. While liver transplantation is the only definitive "cure" for HRS, medical management with vasoconstrictors and i.

Association between neighborhood-based material deprivation and liver transplant waitlist registrants demographics and mortality.

Background & Aims: Liver transplantation for alcohol-related liver disease (ARLD) has increased. We examined temporal trends in ARLD listing practices by neighborhood deprivation and evaluated the impact of neighborhood deprivation on waitlist mortality.

Methods: We included all adults > 18 years listed 2008-2019 in the UNOS registry.

Nonselective beta-blockers may lead to stage 2 acute kidney injury and waitlist mortality in child class C cirrhosis.

Background And Aims: Nonselective beta-blockers (NSBB) protect patients with compensated cirrhosis; however, it is unclear if NSBB is associated with acute kidney injury (AKI) in patients with decompensated cirrhosis. We aimed to determine if the use of NSBB was associated with an increased risk of stage II AKI or greater and waitlist mortality (WLM) among patients with decompensated cirrhosis awaiting liver transplant stratified by cirrhosis severity.

Methods: Included were 1816 outpatients listed for liver transplantation at UCSF from June 2012 to April 2022.

Prognostic significance of acute kidney injury stage 1B in hospitalized patients with cirrhosis: A US nationwide study.

Understanding the prognostic significance of acute kidney injury (AKI) stage 1B [serum creatinine (sCr) ≥1.5 mg/dL] compared with stage 1A (sCr < 1.5 mg/dL) in a US population is important as it can impact initial management decisions for AKI in hospitalized cirrhosis patients.

Clinical Characteristics Associated With Posttransplant Survival Among Adults 70 Years Old or Older Undergoing Liver Transplantation.

Goals: We sought to identify pre-liver transplantation (LT) characteristics among older adults associated with post-LT survival.

Background: The proportion of older patients undergoing deceased-donor liver transplantation (DDLT) has increased over time.

Study: We analyzed adult DDLT recipients in the United Network for Organ Sharing registry from 2016 through 2020, excluding patients listed as status 1 or with a model of end-stage liver disease exceptions for hepatocellular carcinoma.