Gifu University conducts survey on patients with liver cirrhosis: Acute kidney injury development deteriorates prognosis

A group led by Professor Masahito Shimizu and Dr. Takao Miwa (part-time lecturer of the Health Administration Center) of the Department of Gastroenterology, Graduate School of Medicine at Gifu University, has announced the results of their multicenter survey on acute kidney injury (AKI) in patients with liver cirrhosis showing that the development of AKI was associated with poorer prognosis. Among 567 patients with cirrhosis included in the survey, those who developed AKI had a significantly poorer prognosis. Amino acid imbalance, alcohol-associated and metabolic dysfunction-associated steatohepatitis were risk factors for AKI development. The findings are expected to contribute to preventing AKI development and extending healthy life expectancy. The results were published in the June 11 issue of the Journal of Gastroenterology, an international journal.

AKI is a serious complication of cirrhosis, occurring in 30% of hospitalized patients with cirrhosis, and the mortality rate in cirrhotic patients with AKI is reported to be 6−7 times higher than those without AKI. Meanwhile, the association between AKI development and mortality in Japanese patients with cirrhosis and the risk factors for AKI development were unknown.

In this study, the research group examined the incidence of AKI, the prognostic impact of AKI development, and risk factors for AKI development in 567 patients with cirrhosis. The results showed that the cumulative incidence of AKI in the studied population was 14% at 1 year, 23% at 3 years, and 29% at 5 years, and cirrhotic patients who developed AKI had a significantly poorer prognosis than those who did not, with a 6.25 times higher hazard ratio. They also found that the survival rate significantly decreased as the severity of AKI increased. Furthermore, factors associated with the development of AKI were shown to be amino acid imbalance, alcohol-associated/related liver disease, and metabolic dysfunction-associated steatohepatitis (fatty liver disease associated with obesity, diabetes, and other endocrine and metabolic disorders).

In fact, compared to patients with cirrhosis caused by viral hepatitis such as hepatitis B and hepatitis C, those with alcohol-associated/related liver disease and metabolic dysfunction-associated steatohepatitis were at higher risks of developing AKI with 2.12 times and 2.72 times higher hazard ratios, respectively. Patients with cirrhosis have an altered blood amino acid concentration profile, known as amino acid imbalance, with a decrease in branched-chain amino acids, such as leucine, isoleucine, and valine, and an increase in aromatic amino acids, such as phenylalanine, tryptophan, and tyrosine. Risk factors such as amino acid imbalance and fatty liver disease related to alcohol and metabolic dysfunction may be improved by nutritional therapy or lifestyle modification.

Miwa said, "In this study, we investigated the incidence of AKI, its prognostic impact, and risk factors for its development in patients with liver cirrhosis in Japan. This survey was a multicenter study, and we would like to thank all the doctors who cooperated. We hope that accumulating evidence on cirrhosis complications will contribute to countering complications of patients with cirrhosis and extending the healthy life expectancy."

Journal Information
Publication: Journal of Gastroenterology
Title: Acute kidney injury development is associated with mortality in Japanese patients with cirrhosis: impact of amino acid imbalance
DOI: 10.1007/s00535-024-02126-7