Chronic kidney disease in cirrhosis: a study of inpatients from a global perspective

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Background The prevalence of chronic kidney disease (CKD), defined as a glomerular filtration rate (GFR) of <60 mL/min/1.73 m 2 for >3 months, is rising in the global population. Objective To assess the global prevalence of CKD in cirrhosis and how it impacts the prognosis of these patients. Design The Chronic Liver Disease Evolution and Registry for Events and Decompensation consortium prospectively enrolled non-electively admitted cirrhosis patients from 127 sites globally, each with up to 100 patients. Data collected were demographics, comorbid conditions, cirrhosis history, hospital course and patient outcomes. Patients were divided into those with (CKD+) and without CKD (CKD–) and compared. We also compared patients from different World Bank income strata. Results Of 7040 inpatients enrolled, the global prevalence of CKD was 18.17%, with the highest prevalence observed in high-income countries (HICs), which paralleled their higher prevalence of metabolic syndrome. CKD+ patients had lower median enrolment GFR (32 (21, 44) mL/min/1.73 m 2 ) when compared with CKD– patients (88 (63, 117) mL/min/1.73 m 2 , p<0.0001), associated with a more complex history of cirrhosis complications, with ascites occurring in 76.5% of CKD+ versus 61.1% of patients with CKD- (p<0.0001). The most common in-hospital complication was the development of AKI (59.4%) in CKD+ versus 27% in CKD– patients (p<0.0001). CKD was associated with higher in-hospital and 30-day postdischarge mortality (both p<0.0001). Conclusions The presence of CKD negatively impacts the prognosis of admitted patients with cirrhosis in a global cohort. Meticulous management of ascites and lifestyle changes, especially in HICs, may improve the outcome of these patients.

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