Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis
Florence Wong,Mitra K. Nadim,John A. Kellum,Francesco Salerno,Rinaldo Bellomo,Alexander L. Gerbes,Paolo Angeli,Richard Moreau,Andrew Davenport,Rajiv Jalan,Claudio Ronco,Yuri Genyk,Vicente Arroyo +12 more
TLDR
Accepting this new classification will allow studies into the epidemiology, incidence, prevalence, natural history and the development of new treatments for these subtypes of renal dysfunction in cirrhosis.Abstract:
Objectives To propose an improvement on the current classification of renal dysfunction in cirrhosis. Clinicians caring for patients with cirrhosis recognize that the development of renal dysfunction is associated with significant morbidity and mortality. While most cases of renal dysfunction in cirrhosis are functional in nature, developed as a result of changes in haemodynamics, cardiac function, and renal auto-regulation, there is an increasing number of patients with cirrhosis and structural changes in their kidney as a cause of renal dysfunction. Therefore, there is a need for a newer classification to include both functional and structural renal diseases. Design A working party consisting of specialists from multiple disciplines conducted literature search and developed summary statements, incorporating the renal dysfunction classification used in nephrology. These were discussed and revised to produce this proposal. Setting Multi-disciplinary international meeting. Patients None. Interventions Literature search using keywords of cirrhosis, renal dysfunction, acute kidney injury (AKI), chronic kidney injury (CKD), and hepatorenal syndrome. Results Acute kidney injury will include all causes of acute deterioration of renal function as indicated by an increase in serum creatinine of >50% from baseline, or a rise in serum creatinine of $26.4mol/L ($0.3mg/dL) in <48hours. Chronic renal disease will be defined as an estimated glomerular filtration rate (GFR) of <60ml/min calculated using the Modification of Diet in Renal Disease 6 (MDRD6) formula, recognising that the MDRD6 formula is not perfect for the cirrhotic patients and this may change as improved means of estimating GFR becomes available. Acute on chronic kidney disease will be defined as AKI superimposed on existing chronic renal disease using the above definitions for AKI and CKD. Conclusions Accepting this new classification will allow studies into the epidemiology, incidence, prevalence, natural history and the development of new treatments for these subtypes of renal dysfunction in cirrhosis. Acute kidney injury (AKI) is common in patients with cirrhosis and ascites, occurring in up to 19% of cirrhotic patients admitted to hospital. In addition, chronic kidney disease (CKD) occurs in approximately 1% of all patients with cirrhosis. 1read more
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Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury
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TL;DR: The panel of experts, having emphasised the importance of initiating aetiologic treatment for any degree of hepatic disease at the earliest possible stage, extended its work to all the complications of cirrhosis which had not been covered by the European Association for the Study of the Liver guidelines.
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Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation
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References
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A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation
TL;DR: The purpose of this study was to develop an equation from MDRD Study data that could improve the prediction of GFR from serum creatinine concentration, and major clinical decisions in general medicine, geriatrics, and oncology are made by using the Cockcroft-Gault formula and other formulas to predict the level of renal function.
Journal Article
K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification
Andrew S. Levey,Josef Coresh,Kline Bolton,Bruce Culleton,Kathy Schiro Harvey,T. Alp Ikizler,Cynda Ann Johnson,Annamaria T. Kausz,Paul L. Kimmel,John W. Kusek,Adeera Levin,Kenneth L. Minaker,Robert Nelson,Helmut G. Rennke,Michael Steffes,Beth Witten,Ronald J. Hogg,Susan Furth,Kevin V. Lemley,Ronald J. Portman,George Schwartz,Joseph Lau,Ethan M Balk,Ronald D. Perrone,Tauqeer Karim,Lara Rayan,Inas Al-Massry,Priscilla Chew,Brad C. Astor,Deirdre De Vine,Garabed Eknoyan,Nathan W. Levin,Sally Burrows-Hudson,William F. Keane,Alan S. Kliger,Derrick Latos,Donna Mapes,Edith Oberley,Kerry Willis,George R. Bailie,Gavin J. Becker,Jerrilynn Burrowes,David Churchill,Allan J. Collins,William Couser,Dick DeZeeuw,Alan Garber,Thomas Golper,Frank A. Gotch,Antonio M. Gotto,Joel W. Greer,Richard H. Grimm,Ramon G. Hannah,Jaime Herrera Acosta,Ronald J. Hogg,Lawrence G. Hunsicker,Michael J. Klag,Saulo Klahr,Caya Lewis,Edmund G. Lowrie,Arthur J. Matas,Sally McCulloch,Maureen Michael,Joseph V. Nally,John M. Newmann,Allen R. Nissenson,Keith Norris,William F. Owen,Thakor G. Patel,Glenda Payne,Rosa A. Rivera-Mizzoni,David A. Smith,Robert A. Star,Theodore Steinman,Fernando Valderrábano,John Walls,Jean Pierre Wauters,Nanette Wenger,Josephine P. Briggs +78 more
TL;DR: In the early 1990s, the National Kidney Foundation (K/DOQI) developed a set of clinical practice guidelines to define chronic kidney disease and to classify stages in the progression of kidney disease.
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Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group.
TL;DR: A 2-day consensus conference on acute renal failure (ARF) in critically ill patients was organized by ADQI as discussed by the authors, where the authors sought to review the available evidence, make recommendations and delineate key questions for future studies.
Journal ArticleDOI
Acute Kidney Injury Network: Report of an Initiative to Improve Outcomes in Acute Kidney Injury
Ravindra L. Mehta,John A. Kellum,Sudhir V. Shah,Bruce A. Molitoris,Claudio Ronco,David G. Warnock,Adeera Levin +6 more
TL;DR: The Acute Kidney Injury Network (AKI Network) as discussed by the authors is a multidisciplinary collaborative network focused on AKI, which was established to improve care for patients with or at risk for AKI.
Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury
Ravindra L. Mehta,John A. Kellum,Sudhir V. Shah,Bruce A. Molitoris,Claudio Ronco,David G. Warnock,Adeera Levin +6 more
TL;DR: An initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI is described.