Browsing by Author "Ouyang, Tianqi"

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    Acute Kidney Injury in Patients with Cirrhosis and Chronic Kidney Disease: Results from the HRS-HARMONY Consortium
    (Elsevier, 2024) St. Hillien, Shelsea A.; Robinson, Jevon E.; Ouyang, Tianqi; Patidar, Kavish R.; Belcher, Justin M.; Cullaro, Giuseppe; Regner, Kevin R.; Chung, Raymond T.; Ufere, Nneka; Velez, Juan Carlos Q.; Neyra, Javier A.; Asrani, Sumeet K.; Wadei, Hani; Teixeira, J. Pedro; Saly, Danielle L.; Levitsky, Josh; Orman, Eric; Sawinski, Deirdre; Dageforde, Leigh Anne; Allegrietti, Andrew S.; Medicine, School of Medicine
    Background & Aims Chronic kidney disease (CKD) frequency is increasing in patients with cirrhosis and these individuals often experience acute kidney injury (AKI). Direct comparisons of outcomes between AKI-only versus AKI on CKD (AoCKD) among patients with cirrhosis are not well described. Methods A total of 2057 patients with cirrhosis and AKI across 11 hospital networks from the HRS-HARMONY consortium were analyzed (70% AKI-only and 30% AoCKD). The primary outcome was unadjusted and adjusted 90-day mortality, with transplant as a competing risk, using Fine and Gray analysis. Results Compared with patients with AKI-only, patients with AoCKD had higher median admission creatinine (2.25 [interquartile range, 1.7–3.2] vs 1.83 [1.38–2.58] mg/dL) and peak creatinine (2.79 [2.12–4] vs 2.42 [1.85–3.50] mg/dL) but better liver function parameters (total bilirubin 1.5 [interquartile range, 0.7–3.1] vs 3.4 [1.5–9.3] mg/dL; and international normalized ratio 1.4 [interquartile range, 1.2–1.8] vs 1.7 [1.39–2.2]; P < .001 for all). Patients with AoCKD were more likely to have metabolic dysfunction associated steatotic liver disease cirrhosis (31% vs 17%) and less likely to have alcohol-associated liver disease (26% vs 45%; P < .001 for both). Patients with AKI-only had higher unadjusted mortality (39% vs 30%), rate of intensive care unit admission (52% vs 35%; P < .001 for both), and use of renal-replacement therapy (20% vs 15%; P = .005). After adjusting for age, race, sex, transplant listing status, and Model for End-Stage Liver Disease–Sodium score, AoCKD was associated with a lower 90-day mortality compared with AKI-only (subhazard ratio, 0.72; 95% confidence interval, 0.61–0.87). Conclusions In hospitalized patients with AKI and cirrhosis, AoCKD was associated with lower 90-day mortality compared with AKI-only. This may be caused by the impact of worse liver function parameters in the AKI-only group on short-term outcomes. Further study of the complicated interplay between acute and chronic kidney disease in cirrhosis is needed.
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    Association of Hepatorenal Syndrome-Acute Kidney Injury with Mortality in Patients with Cirrhosis Requiring Renal Replacement Therapy: Results from the HRS-HARMONY Consortium
    (Wolters Kluwer, 2025) Cama-Olivares, Augusto; Ouyang, Tianqi; Takeuchi, Tomonori; St. Hillien, Shelsea A.; Robinson, Jevon E.; Chung, Raymond T.; Cullaro, Giuseppe; Karvellas, Constantine J.; Levitsky, Josh; Orman, Eric S.; Patidar, Kavish R.; Regner, Kevin R.; Saly, Danielle L.; Sawinski, Deirdre; Sharma, Pratima; Teixeira, J. Pedro; Ufere, Nneka N.; Velez, Juan Carlos Q.; Wadei, Hani M.; Wahid, Nabeel; Allegretti, Andrew S.; Neyra, Javier A.; Belcher, Justin M.; HRS-HARMONY Consortium; Medicine, School of Medicine
    Key Points: In patients with cirrhosis and AKI requiring renal replacement therapy (RRT), hepatorenal syndrome-AKI was not associated with an increased 90-day mortality when compared with other AKI etiologies. Etiology of AKI may not be a critical factor regarding decisions to trial RRT in acutely ill patients with cirrhosis and AKI. Although elevated, mortality rates in this study are comparable with those reported in general hospitalized patients with AKI requiring RRT. Background: While AKI requiring renal replacement therapy (AKI-RRT) is associated with increased mortality in heterogeneous inpatient populations, the epidemiology of AKI-RRT in hospitalized patients with cirrhosis is not fully known. Herein, we evaluated the association of etiology of AKI with mortality in hospitalized patients with cirrhosis and AKI-RRT in a multicentric contemporary cohort. Methods: This is a multicenter retrospective cohort study using data from the HRS-HARMONY consortium, which included 11 US hospital network systems. Consecutive adult patients admitted in 2019 with cirrhosis and AKI-RRT were included. The primary outcome was 90-day mortality, and the main independent variable was AKI etiology, classified as hepatorenal syndrome (HRS-AKI) versus other (non–HRS-AKI). AKI etiology was determined by at least two independent adjudicators. We performed Fine and Gray subdistribution hazard analyses adjusting for relevant clinical variables. Results: Of 2063 hospitalized patients with cirrhosis and AKI, 374 (18.1%) had AKI-RRT. Among them, 65 (17.4%) had HRS-AKI and 309 (82.6%) had non–HRS-AKI, which included acute tubular necrosis in most cases (62.6%). Continuous renal replacement therapy was used as the initial modality in 264 (71%) of patients, while intermittent hemodialysis was used in 108 (29%). The HRS-AKI (versus non–HRS-AKI) group received more vasoconstrictors for HRS management (81.5% versus 67.9%), whereas the non–HRS-AKI group received more mechanical ventilation (64.3% versus 50.8%) and more continuous renal replacement therapy (versus intermittent hemodialysis) as the initial RRT modality (73.9% versus 56.9%). In the adjusted model, HRS-AKI (versus non–HRS-AKI) was not independently associated with increased 90-day mortality (subdistribution hazard ratio, 1.36; 95% confidence interval, 0.95 to 1.94). Conclusions: In this multicenter contemporary cohort of hospitalized adult patients with cirrhosis and AKI-RRT, HRS-AKI was not independently associated with an increased risk of 90-day mortality when compared with other AKI etiologies. The etiology of AKI appears less relevant than previously considered when evaluating the prognosis of hospitalized adult patients with cirrhosis and AKI requiring RRT.
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    Incidence and outcomes of acute kidney injury including hepatorenal syndrome in hospitalized patients with cirrhosis in the US
    (Elsevier, 2023) Patidar, Kavish R.; Belcher, Justin M.; Regner, Kevin R.; St. Hillien, Shelsea A.; Simonetto, Douglas A.; Asrani, Sumeet K.; Neyra, Javier A.; Sharma, Pratima; Velez, Juan Carlos Q.; Wadei, Hani; Nadim, Mitra K.; Chung, Raymond T.; Seethapathy, Ritu; Parada, Xavier Vela; Ouyang, Tianqi; Ufere, Nneka N.; Robinson, Jevon E.; McLean Diaz, Paige; Wilechansky, Robert M.; Przybyszewski, Eric M.; Smith, Thomas N.; Ali, Arzina Aziz; Orman, Eric S.; Schulz, Philipp; Siddiqui, Salaah M.; Shabbir, Rehma; Liu, Lucas J.; Cama-Olivares, Augusto; Flannery, Alexander H.; Baker, Megan L.; Gunasekaran, Deepthi; Aswine, Adeline; Issa, Rafik; Li, Jay; Verma, Shreya; Chalmers, Dustin; Varghese, Vipin; Lam, Walter; Mohamed, Muner; Kovacic, Rosemary; Gaddy, Anna; Attieh, Rose Mary; Cortes, Pedro; Semnani, Sahar; Wang, Lin; Khemichian, Saro; Allegretti, Andrew S.; HRS-HARMONY consortium; Medicine, School of Medicine
    Background & aims: Acute kidney injury (AKI) in cirrhosis is common and associated with high morbidity, but the incidence rates of different etiologies of AKI are not well described in the US. We compared incidence rates, practice patterns, and outcomes across etiologies of AKI in cirrhosis. Methods: We performed a retrospective cohort study of 11 hospital networks, including consecutive adult patients admitted with AKI and cirrhosis in 2019. The etiology of AKI was adjudicated based on pre-specified clinical definitions (prerenal/hypovolemic AKI, hepatorenal syndrome [HRS-AKI], acute tubular necrosis [ATN], other). Results: A total of 2,063 patients were included (median age 62 [IQR 54-69] years, 38.3% female, median MELD-Na score 26 [19-31]). The most common etiology was prerenal AKI (44.3%), followed by ATN (30.4%) and HRS-AKI (12.1%); 6.0% had other AKI, and 7.2% could not be classified. In our cohort, 8.1% of patients received a liver transplant and 36.5% died by 90 days. The lowest rate of death was observed in patients with prerenal AKI (22.2%; p <0.001), while death rates were higher but not significantly different from each other in those with HRS-AKI and ATN (49.0% vs. 52.7%; p = 0.42). Using prerenal AKI as a reference, the adjusted subdistribution hazard ratio (sHR) for 90-day mortality was higher for HRS-AKI (sHR 2.78; 95% CI 2.18-3.54; p <0.001) and ATN (sHR 2.83; 95% CI 2.36-3.41; p <0.001). In adjusted analysis, higher AKI stage and lack of complete response to treatment were associated with an increased risk of 90-day mortality (p <0.001 for all). Conclusion: AKI is a severe complication of cirrhosis. HRS-AKI is uncommon and is associated with similar outcomes to ATN. The etiology of AKI, AKI stage/severity, and non-response to treatment were associated with mortality. Further optimization of vasoconstrictors for HRS-AKI and supportive therapies for ATN are needed. Impact and implications: Acute kidney injury (AKI) in cirrhosis carries high morbidity, and management is determined by the etiology of injury. However, a large and well-adjudicated multicenter database from US centers that uses updated AKI definitions is lacking. Our findings demonstrate that acute tubular necrosis and hepatorenal syndrome have similar outcomes (∼50% mortality at 90 days), though hepatorenal syndrome is uncommon (12% of all AKI cases). These findings represent practice patterns at US transplant/tertiary centers and can be used as a baseline, presenting the situation prior to the adoption of terlipressin in the US.