Liver and Bile
J Gastroenterol Hepatol. 2024;39(3):560–7
Analyzing the utility of renal replacement therapy to manage hepatorenal syndrome in alcoholic hepatitis without liver transplantation: A nationwide analysis
Background: Hepatorenal syndrome (HRS) frequently complicates alcoholic hepatitis (AH) and portends poor survival in this population. Published literature indicates mixed benefits from renal replacement therapy (RRT) for HRS refractory to medical management. Therefore, the authors sought to assess the utilization of RRT in AH and clinical outcomes at a national level.
Methods: Using the International Classification of Diseases, 10th Revision (ICD-10) codes, they identified adult patients with AH with a coexisting diagnosis of HRS from the National Readmission Database 2016 through 2019. Mortality, morbidity, and resource utilization were compared. Additionally, proportions using the Fisher exact test and computed adjusted p-values based on multivariate regression analysis were compared. Analyses were performed using Stata, version 14.2, considering a 2-sided p < 0.05 as statistically significant.
Results: A total of 73,203 patients with AH were included in the analysis (mean age, 46.2 years). A total of 3620 individuals had HRS diagnosis (5%), of which 14.7% (n = 532) underwent RRT. HRS patients receiving RRT had a higher mortality rate than those who did not (adjusted odds ratio [aOR] = 1.8, 95% confidence interval [CI]: 1.3–2.6, p = 0.01), along with higher resource utilization. Only those patients with HRS who underwent liver transplantation experienced a mortality reduction (24.4% for those not receiving RRT and 36.5% for those receiving RRT).
Conclusions: Renal replacement therapy (RRT) is associated with higher mortality and morbidity when offered to patients with alcoholic hepatitis (AH) and hepatorenal syndrome (HRS), who do not undergo liver transplantation. Therefore, these results suggest careful selection of AH patients when deciding to initiate RRT for HRS.
DOI: 10.1111/jgh.16388