{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:28:13Z","timestamp":1787099293282,"version":"build-2736575974"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":69,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nephrol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute kidney injury (AKI) is a common complication in critically ill patients with decompensated cirrhosis who often require kidney replacement therapy (KRT) but prognostic uncertainty remains in critically ill ICU patients, particularly regarding short- and medium- term outcomes after KRT initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective, single center cohort analysis of critically ill patients with cirrhosis and AKI requiring KRT in the medical ICU of a tertiary care liver transplant center. We gathered data pertaining to CLIF-C ACLF and MELD-Na on the day of ICU admission. Survival outcomes of interest included days to death from the start of KRT, and at one- and six-month interval.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      131 patients met the inclusion criteria of which 21 were listed for liver transplantation at time of ICU admission. 86.3% of patients were diagnosed with acute tubular necrosis (ATN) and the remaining with HRS-AKI. 69.5% of patients were prescribed Continuous Veno Venous Hemofiltration (CVVH) as initial KRT modality. Mean clinical severity scores were MELD-Na 33.1 (SD 8.3) and CLIF-C ACLF score 63.4 (SD 10.3). 21.4% and 15.3% of the 131 patients included, were alive at 1 and 6 months after ICU admission. Median survival time from KRT initiation in ICU was 5 days (IQR 3-12.5 days). Survival did not differ significantly by AKI etiology or transplant listing status although this is limited by small sample size and dynamic nature of transplant listing status. In unadjusted analyses, survival differed by initial KRT modality, with higher mortality among patients initiated on CVVH; however, in multivariable Cox regression, only CLIF-C ACLF score [HR 1.03 (1.00- 1.05),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04], platelets [HR 0.997 (0.994\u20130.999),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02] and INR [HR 1.22 (1.00-1.49),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05] were significantly associated with survival time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AKI requiring KRT in critically ill patients with cirrhosis is associated with limited survival. Mortality was primarily associated with overall severity of acute-on-chronic liver failure, as reflected by CLIF-C ACLF score, rather than MELD-Na. No clear differences were observed by AKI etiology or transplant listing status. Although unadjusted survival differed by initial KRT modality, this likely reflects confounding by illness severity rather than a modality-specific effect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12882-026-05096-5","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T13:45:31Z","timestamp":1781185531000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognosis of critically ill patients with cirrhosis and acute kidney injury initiated on dialysis"],"prefix":"10.1186","volume":"27","author":[{"given":"Eric","family":"Kerns","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Agameya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Abdelfattah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine","family":"Molino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandipan","family":"Shringi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avignat","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"issue":"6","key":"5096_CR1","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1001\/jama.2013.13805","volume":"310","author":"CJ Murray","year":"2013","unstructured":"Murray CJ, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D, et al. The state of US health, 1990\u20132010: burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591\u2013608.","journal-title":"JAMA"},{"issue":"3","key":"5096_CR2","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/S1665-2681(19)30924-X","volume":"11","author":"J Muci\u00f1o-Bermejo","year":"2012","unstructured":"Muci\u00f1o-Bermejo J, Carrillo-Esper R, Uribe M, M\u00e9ndez-S\u00e1nchez N. Acute kidney injury in critically ill cirrhotic patients: a review. Ann Hepatol. 2012;11(3):301\u201310.","journal-title":"Ann Hepatol"},{"issue":"2","key":"5096_CR3","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1002\/hep.25735","volume":"57","author":"JM Belcher","year":"2013","unstructured":"Belcher JM, Garcia-Tsao G, Sanyal AJ, Bhogal H, Lim JK, Ansari N, et al. Association of AKI with mortality and complications in hospitalized patients with cirrhosis. Hepatology. 2013;57(2):753\u201362.","journal-title":"Hepatology"},{"issue":"3","key":"5096_CR4","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.jhep.2013.04.036","volume":"59","author":"C Fagundes","year":"2013","unstructured":"Fagundes C, Barreto R, Guevara M, Garcia E, Sol\u00e0 E, Rodr\u00edguez E, et al. A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis. J Hepatol. 2013;59(3):474\u201381.","journal-title":"J Hepatol"},{"issue":"3","key":"5096_CR5","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1016\/j.jhep.2013.03.039","volume":"59","author":"S Piano","year":"2013","unstructured":"Piano S, Rosi S, Maresio G, Fasolato S, Cavallin M, Romano A, et al. Evaluation of the Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites. J Hepatol. 2013;59(3):482\u20139.","journal-title":"J Hepatol"},{"issue":"5","key":"5096_CR6","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1016\/j.jhep.2020.04.043","volume":"73","author":"AP Desai","year":"2020","unstructured":"Desai AP, Knapp SM, Orman ES, Ghabril MS, Nephew LD, Anderson M, et al. Changing epidemiology and outcomes of acute kidney injury in hospitalized patients with cirrhosis - a US population-based study. J Hepatol. 2020;73(5):1092\u20139.","journal-title":"J Hepatol"},{"issue":"6","key":"5096_CR7","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1002\/hep.22605","volume":"48","author":"G Garcia-Tsao","year":"2008","unstructured":"Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology. 2008;48(6):2064\u201377.","journal-title":"Hepatology"},{"issue":"4","key":"5096_CR8","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1016\/j.ccc.2015.06.009","volume":"31","author":"CJ Karvellas","year":"2015","unstructured":"Karvellas CJ, Durand F, Nadim MK. Acute Kidney Injury in Cirrhosis. Crit Care Clin. 2015;31(4):737\u201350.","journal-title":"Crit Care Clin"},{"issue":"5","key":"5096_CR9","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1016\/j.kint.2017.04.048","volume":"92","author":"A Davenport","year":"2017","unstructured":"Davenport A, Sheikh MF, Lamb E, Agarwal B, Jalan R. Acute kidney injury in acute-on-chronic liver failure: where does hepatorenal syndrome fit? Kidney Int. 2017;92(5):1058\u201370.","journal-title":"Kidney Int"},{"key":"5096_CR10","doi-asserted-by":"publisher","first-page":"385","DOI":"10.2147\/CEG.S323778","volume":"14","author":"A Chaney","year":"2021","unstructured":"Chaney A. A Review for the Practicing Clinician: Hepatorenal Syndrome, a Form of Acute Kidney Injury, in Patients with Cirrhosis. Clin Exp Gastroenterol. 2021;14:385\u201396.","journal-title":"Clin Exp Gastroenterol"},{"issue":"4","key":"5096_CR11","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1016\/j.jhep.2019.07.002","volume":"71","author":"P Angeli","year":"2019","unstructured":"Angeli P, Garcia-Tsao G, Nadim MK, Parikh CR. News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document. J Hepatol. 2019;71(4):811\u201322.","journal-title":"J Hepatol"},{"issue":"5","key":"5096_CR12","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.2215\/CJN.01340406","volume":"1","author":"HM Wadei","year":"2006","unstructured":"Wadei HM, Mai ML, Ahsan N, Gonwa TA. Hepatorenal syndrome: pathophysiology and management. Clin J Am Soc Nephrol. 2006;1(5):1066\u201379.","journal-title":"Clin J Am Soc Nephrol"},{"issue":"1","key":"5096_CR13","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1038\/s41572-018-0022-7","volume":"4","author":"P Gin\u00e8s","year":"2018","unstructured":"Gin\u00e8s P, Sol\u00e0 E, Angeli P, Wong F, Nadim MK, Kamath PS. Hepatorenal syndrome. Nat Rev Dis Primers. 2018;4(1):23.","journal-title":"Nat Rev Dis Primers"},{"issue":"8","key":"5096_CR14","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1056\/NEJMra2215289","volume":"388","author":"MK Nadim","year":"2023","unstructured":"Nadim MK, Garcia-Tsao G. Acute Kidney Injury in Patients with Cirrhosis. N Engl J Med. 2023;388(8):733\u201345.","journal-title":"N Engl J Med"},{"issue":"1\u20133","key":"5096_CR15","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1159\/000334149","volume":"33","author":"TA Gonwa","year":"2012","unstructured":"Gonwa TA, Wadei HM. The challenges of providing renal replacement therapy in decompensated liver cirrhosis. Blood Purif. 2012;33(1\u20133):144\u20138.","journal-title":"Blood Purif"},{"issue":"3","key":"5096_CR16","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1111\/sdi.12224","volume":"27","author":"JM Belcher","year":"2014","unstructured":"Belcher JM. Is there a role for dialysis in patients with hepatorenal syndrome who are not liver transplant candidates? Semin Dial. 2014;27(3):288\u201391.","journal-title":"Semin Dial"},{"issue":"5","key":"5096_CR17","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1081\/JDI-200035988","volume":"26","author":"RK Capling","year":"2004","unstructured":"Capling RK, Bastani B. The clinical course of patients with type 1 hepatorenal syndrome maintained on hemodialysis. Ren Fail. 2004;26(5):563\u20138.","journal-title":"Ren Fail"},{"issue":"3","key":"5096_CR18","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1007\/s12072-016-9706-9","volume":"10","author":"GN Nadkarni","year":"2016","unstructured":"Nadkarni GN, Simoes PK, Patel A, Patel S, Yacoub R, Konstantinidis I, et al. National trends of acute kidney injury requiring dialysis in decompensated cirrhosis hospitalizations in the United States. Hepatol Int. 2016;10(3):525\u201331.","journal-title":"Hepatol Int"},{"issue":"2","key":"5096_CR19","doi-asserted-by":"publisher","first-page":"135","DOI":"10.3109\/08860229509026250","volume":"17","author":"F Keller","year":"1995","unstructured":"Keller F, Heinze H, Jochimsen F, Passfall J, Schuppan D, B\u00fcttner P. Risk factors and outcome of 107 patients with decompensated liver disease and acute renal failure (including 26 patients with hepatorenal syndrome): the role of hemodialysis. Ren Fail. 1995;17(2):135\u201346.","journal-title":"Ren Fail"},{"issue":"1","key":"5096_CR20","first-page":"287","volume":"8","author":"SP Wilkinson","year":"1977","unstructured":"Wilkinson SP, Weston MJ, Parsons V, Williams R. Dialysis in the treatment of renal failure in patients with liver disease. Clin Nephrol. 1977;8(1):287\u201392.","journal-title":"Clin Nephrol"},{"issue":"12","key":"5096_CR21","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1111\/j.1440-1746.2004.03471.x","volume":"19","author":"O Witzke","year":"2004","unstructured":"Witzke O, Baumann M, Patschan D, Patschan S, Mitchell A, Treichel U, et al. Which patients benefit from hemodialysis therapy in hepatorenal syndrome? J Gastroenterol Hepatol. 2004;19(12):1369\u201373.","journal-title":"J Gastroenterol Hepatol"},{"issue":"1","key":"5096_CR22","doi-asserted-by":"publisher","first-page":"16","DOI":"10.2215\/CJN.03610417","volume":"13","author":"AS Allegretti","year":"2018","unstructured":"Allegretti AS, Parada XV, Eneanya ND, Gilligan H, Xu D, Zhao S, et al. Prognosis of Patients with Cirrhosis and AKI Who Initiate RRT. Clin J Am Soc Nephrol. 2018;13(1):16\u201325.","journal-title":"Clin J Am Soc Nephrol"},{"issue":"6","key":"5096_CR23","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1111\/liv.13389","volume":"37","author":"K Staufer","year":"2017","unstructured":"Staufer K, Roedl K, Kivaranovic D, Drolz A, Horvatits T, Rasoul-Rockenschaub S, et al. Renal replacement therapy in critically ill liver cirrhotic patients-outcome and clinical implications. Liver Int. 2017;37(6):843\u201350.","journal-title":"Liver Int"},{"issue":"10","key":"5096_CR24","doi-asserted-by":"publisher","first-page":"3710","DOI":"10.1007\/s10620-024-08623-2","volume":"69","author":"PM Diaz","year":"2024","unstructured":"Diaz PM, Saly DL, Horick N, Petrosyan R, Gitto Z, Indriolo T, et al. Prognosis of Transplant-Ineligible Patients with Cirrhosis and Acute Kidney Injury Who Initiate Renal Replacement Therapy. Dig Dis Sci. 2024;69(10):3710\u201320.","journal-title":"Dig Dis Sci"},{"issue":"22","key":"5096_CR25","doi-asserted-by":"publisher","first-page":"2137","DOI":"10.1056\/NEJMra1914900","volume":"382","author":"V Arroyo","year":"2020","unstructured":"Arroyo V, Moreau R, Jalan R. Acute-on-Chronic Liver Failure. N Engl J Med. 2020;382(22):2137\u201345.","journal-title":"N Engl J Med"},{"issue":"1","key":"5096_CR26","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1111\/j.1523-1755.2005.00408.x","volume":"68","author":"LP Wong","year":"2005","unstructured":"Wong LP, Blackley MP, Andreoni KA, Chin H, Falk RJ, Klemmer PJ. Survival of liver transplant candidates with acute renal failure receiving renal replacement therapy. Kidney Int. 2005;68(1):362\u201370.","journal-title":"Kidney Int"},{"issue":"1","key":"5096_CR27","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1053\/j.ajkd.2021.09.025","volume":"80","author":"PL Wang","year":"2022","unstructured":"Wang PL, Silver SA, Djerboua M, Thanabalasingam S, Zarnke S, Flemming JA. Recovery From Dialysis-Treated Acute Kidney Injury in Patients With Cirrhosis: A Population-Based Study. Am J Kidney Dis. 2022;80(1):55\u2013e641.","journal-title":"Am J Kidney Dis"},{"issue":"5","key":"5096_CR28","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1016\/j.jhep.2014.06.012","volume":"61","author":"R Jalan","year":"2014","unstructured":"Jalan R, Saliba F, Pavesi M, Amoros A, Moreau R, Gin\u00e8s P, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol. 2014;61(5):1038\u201347.","journal-title":"J Hepatol"},{"issue":"4","key":"5096_CR29","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.cgh.2013.08.027","volume":"12","author":"Z Poonja","year":"2014","unstructured":"Poonja Z, Brisebois A, van Zanten SV, Tandon P, Meeberg G, Karvellas CJ. Patients with cirrhosis and denied liver transplants rarely receive adequate palliative care or appropriate management. Clin Gastroenterol Hepatol. 2014;12(4):692\u20138.","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"5","key":"5096_CR30","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.1002\/hep.29297","volume":"66","author":"B Rush","year":"2017","unstructured":"Rush B, Walley KR, Celi LA, Rajoriya N, Brahmania M. Palliative care access for hospitalized patients with end-stage liver disease across the United States. Hepatology. 2017;66(5):1585\u201391.","journal-title":"Hepatology"},{"issue":"2","key":"5096_CR31","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1097\/MNH.0000000000000959","volume":"33","author":"AD Bansal","year":"2024","unstructured":"Bansal AD, Patel AA. Dialysis initiation for patients with decompensated cirrhosis when liver transplant is unlikely. Curr Opin Nephrol Hypertens. 2024;33(2):212\u20139.","journal-title":"Curr Opin Nephrol Hypertens"}],"container-title":["BMC Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12882-026-05096-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12882-026-05096-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12882-026-05096-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:07:36Z","timestamp":1787098056000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12882-026-05096-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5096"],"URL":"https:\/\/doi.org\/10.1186\/s12882-026-05096-5","relation":{},"ISSN":["1471-2369"],"issn-type":[{"value":"1471-2369","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]},"assertion":[{"value":"31 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The Lahey Hospital and Medical Center Institutional Review Board approved this study (IRB# 1097668). The need for informed consent was waived. The conduct of the study was in accordance with the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"487"}}