Key takeaways:
- In 2023, nearly a third of hospitalized patients with chronic liver disease had acute kidney injury or hepatorenal syndrome.
- Hospitalization charges per patient also increased from 2018 to 2023.
Among hospitalized patients with chronic liver disease, acute kidney injury and hepatorenal syndrome represent a growing clinical — and potential economic — burden, according to research published in JAMA Network Open.
These findings underscore the need to mitigate this trend through careful management of kidney-related complications in this patient population, researchers noted.
“Improved early identification, linking these patients to appropriate specialty care and ensuring timely initiation of appropriate targeted therapy can help improve outcomes in this patient population,” Robert J. Wong, MD, MS, FACG, FAASLD, clinical associate professor in the division of gastroenterology and hepatology at Stanford University School of Medicine and staff physician at VA Palo Alto Healthcare System, told Healio.
To investigate trends in the incidence of acute kidney injury and hepatorenal syndrome among hospitalized patients with chronic liver disease, as well as associated health care resource use and costs, Wong and colleagues conducted a retrospective, longitudinal cohort study.
They used the Premier Healthcare Database to identify adult patients with chronic liver disease and acute kidney injury or hepatorenal syndrome who were hospitalized in the U.S. between 2018 and 2023.
The researchers adjusted total charges to 2024 U.S. dollars.
Of 4,056,287 hospitalizations of patients with chronic liver disease (mean age, 58.3 years; 55.4% men), 44.9% had Medicare and 26% had Medicaid.
Nearly a third (30.1%) had acute kidney injury (mean age, 62.6 years; 59.7% men; 53.8% on Medicare), and 2.2% had hepatorenal syndrome (mean age, 58.9 years; 60.7% men; 41.6% on Medicare). Alcohol-related disorders were prevalent among patients in both groups (27.9% and 59.6%, respectively).
Nearly all (95.5%) of the patients with hepatorenal syndrome had been diagnosed with liver cirrhosis.
The percentage of patients hospitalized with chronic liver disease increased from 7.4% in 2018 to 9% in 2023, with similar trends reported among those with acute kidney injury (27.1% to 31.2%; P < .001) or hepatorenal syndrome (1.9% to 2.3%; P < .001).
Patient hospitalizations for acute kidney injury with alcohol-related liver disease were consistent from 2018 (20.2%) to 2023 (19.8%). Hospitalizations for hepatorenal syndrome with alcohol-related liver disease increased from 52.8% in 2018 to 59.8% in 2021, then decreased to 56.5% in 2023.
Those with hepatorenal syndrome had significantly higher rates of inpatient mortality (26.4%) than those with acute kidney injury (18.4%; P < .001).
“Overall, one in 12 hospitalizations among adults in the U.S. had a diagnosis of chronic liver disease or cirrhosis, which has been increasing,” Wong said. “Among this cohort, the proportion with acute kidney injury and hepatorenal syndrome has steadily increased, and in 2023, nearly one-third of hospitalized patients with chronic liver disease had acute kidney injury or hepatorenal syndrome.”
The researchers also noted increases in the costs associated with these hospitalizations.
From 2018 to 2023, mean total hospitalization charges per patient rose from $141,005 to $165,548 for patients with acute kidney injury and from $153,456 to $186,760 for those with hepatorenal syndrome.
The projected yearly incidence of hospitalized patients with chronic liver disease also increased during this time — from 2,288,242 in 2018 to 2,754,542 in 2023. Projected inpatient numbers rose from 619,775 to 860,119 patients for acute kidney injury and from 42,930 to 63,381 patients for hepatorenal syndrome.
According to Wong, these data add to the body of evidence showing the increasing clinical and economic burden of chronic liver disease in the United States.
“Our study specifically highlights the important clinical implications of acute kidney injury or hepatorenal syndrome, which are known complications in patients with progressive liver disease,” Wong said. “We hope that our data increase awareness among health care providers caring for these high-risk patients and highlights the importance of earlier identification and connection to appropriate treatment, which can potentially improve patient outcomes.”
Wong encouraged clinicians to be proactive in managing these complications.
“The key takeaway message we hope to emphasize with these data is to recognize acute kidney injury or hepatorenal syndrome signs and symptoms in patients with chronic liver disease or cirrhosis, followed by prompt action to link these patients to appropriate specialty care and targeted therapies to improve outcomes,” he said.
For more information:
Robert J. Wong, MD, MS, FACG, FAASLD, can be reached at rwong123@stanford.edu.
Sources/Disclosures
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Disclosures:
Mallinckrodt Pharmaceuticals funded this study. Wong reports grants to the Palo Alto Veterans Institute for Research from Exact Sciences, Durect Corp., Gilead Sciences and Theratechnologies; and uncompensated consulting for Gilead Sciences, Mallinckrodt Pharmaceuticals and Salix Pharmaceuticals.
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