Chronic kidney disease in cirrhosis - A study of inpatients from a global perspective

Background: The prevalence of chronic kidney disease (CKD) defined as a glomerular filtration rate (GFR) of <60mL/minute/1.73 m2 for >3 months, is rising in the global population. Objective: To assess the global prevalence of CKD in cirrhosis and how it impacts the prognosis of these patients. Design: The Chronic Liver Disease Evolution And Registry for Events and Decompensation (CLEARED) consortium prospectively enrolled non-electively admitted cirrhosis patients from 127 sites globally, each up to 100 patients. Data collected were demographics, co-morbid conditions, cirrhosis history, hospital course and patient outcomes. Patients were divided into those with (CKD+) and without CKD (CKD-) and compared. We also compared patients from different World Bank Income strata. Results: Of 7040 inpatients enrolled, the global prevalence of CKD was 18.17%, with the highest prevalence observed in high income (HIC) countries, which paralleled their higher prevalence of metabolic syndrome. CKD+ patients had lower median enrolment GFR (32 [21,44] mL/minute/1.73 m2) when compared to CKD- patients (88 [63,117] mL/minute/1.73 m2, p<0.0001), associated with more complex history of cirrhosis complications, with ascites occurring in 76.5% of CKD+ versus 61.1% of CKD patients (p<0.0001). The most common in-hospital complication was the development of AKI (59.4%) in CKD+ versus 27% in CKD- patients (p<0.0001). CKD was associated with higher in-hospital and 30-day post-discharge mortality (both p<0.0001). Conclusions: The presence of CKD negatively impacts the prognosis of admitted patients with cirrhosis in a global cohort. Meticulous management of ascites and lifestyle changes, especially in HIC countries, may improve the outcome of these patients.