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

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 wh...

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Published in:Hepatology international 2024-06, Vol.18 (3), p.833-869
Main Authors: Maiwall, Rakhi, Singh, Satender Pal, Angeli, Paolo, Moreau, Richard, Krag, Aleksander, Singh, Virender, Singal, Ashwani K., Tan, S. S., Puri, Puneet, Mahtab, Mamun, Lau, George, Ning, Qin, Sharma, Manoj Kumar, Rao, P. N., Kapoor, Dharmesh, Gupta, Subhash, Duseja, Ajay, Wadhawan, Manav, Jothimani, Dinesh, Saigal, Sanjiv, Taneja, Sunil, Shukla, Akash, Puri, Pankaj, Govil, Deepak, Pandey, Gaurav, Madan, Kaushal, Eapen, C. E., Benjamin, Jaya, Chowdhury, Ashok, Singh, Shweta, Salao, Vaishali, Yang, Jin Mo, Hamid, Saeed, Shalimar, Jasuja, Sanjiv, Kulkarni, Anand V., Niriella, Madund A., Tevethia, Harsh Vardhan, Arora, Vinod, Mathur, R. P., Roy, Akash, Jindal, Ankur, Saraf, Neeraj, Verma, Nipun, De, Arka, Choudhary, Narendra S., Mehtani, Rohit, Chand, Phool, Rudra, Omkar, Sarin, Shiv Kumar
Format: Article
Language:English
Subjects:
Acute Kidney Injury - diagnosis
Acute Kidney Injury - etiology
Acute Kidney Injury - therapy
Acute-On-Chronic Liver Failure - complications
Acute-On-Chronic Liver Failure - diagnosis
Acute-On-Chronic Liver Failure - etiology
Acute-On-Chronic Liver Failure - therapy
Bacterial diseases
Colorectal Surgery
Failure
Guidelines
Health services
Hepatology
Humans
Injuries
Kidneys
Liver
Liver Transplantation
Liver transplants
Medicine
Medicine & Public Health
Patients
Surgery
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Summary: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.
ISSN:1936-0533
1936-0541
1936-0541
DOI:10.1007/s12072-024-10650-0