Browsing by Author "Sawinski, Deirdre"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Decreasing deceased donor transplant rates among children (≤6 years) under the new kidney allocation system
    (Elsevier, 2018) Shelton, Brittany A.; Sawinski, Deirdre; Ray, Christopher; Reed, Rhiannon D.; MacLennan, Paul A.; Blackburn, Justin; Young, Carlton J.; Gray, Stephen; Yanik, Megan; Massie, Allan; Segev, Dorry L.; Locke, Jayme E.; Health Policy and Management, School of Public Health
    The Kidney Allocation System (KAS) was implemented in December 2014 with unknown impact on the pediatric waitlist. To understand the effect of KAS on pediatric registrants, deceased donor kidney transplant (DDKT) rate was assessed using interrupted time series analysis and time-to-event analysis. Two allocation eras were defined with an intermediary washout period: Era 1 (01/01/2013-09/01/2014), Era 2 (09/01/2014-03/01/2015), and Era 3(03/01/2015-03/01/2017). When using Cox proportional hazards, there was no significant association between allocation era and DDKT likelihood as compared to Era 1 (Era 3: aHR: 1.07, 95% CI: 0.97-1.18, P = .17). However, this was not consistent across all subgroups. Specifically, while highly sensitized pediatric registrants were consistently less likely to be transplanted than their less sensitized counterparts, this disparity was attenuated in Era 3 (Era 1 aHR: 0.04, 95%CI: 0.01-0.14, P < .001; Era 3 aHR: 0.33, 95% CI: 0.21-0.53, P < .001) whereas the youngest registrants aged 0-6 experienced a 21% decrease in DDKT likelihood in Era 3 as compared to Era 1 (aHR: 0.79, 95% CI: 0.64-0.98, P = .03). Thus, while overall DDKT likelihood remained stable with the introduction of KAS, registrants ≤ 6 years of age were disadvantaged, warranting further study to ensure equitable access to transplantation.