2023
AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review
Garcia-Tsao G, Abraldes J, Rich N, Wong V. AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review. Gastroenterology 2023, 166: 202-210. PMID: 37978969, DOI: 10.1053/j.gastro.2023.10.016.Peer-Reviewed Original ResearchConceptsSpontaneous bacterial peritonitisAcute kidney injuryLarge-volume paracentesisEffective arterial blood volumeVasoactive drugsVariceal hemorrhageArterial blood volumeHRS-AKIUncomplicated ascitesIntravenous albuminVolume statusPractice UpdateBlood volumeChronic liver failure grade 3Best practice advice statementsClinical Practice Updates CommitteeEnd-stage liver diseaseAGA Clinical Practice UpdateForms of AKIIntensive care unit monitoringAGA Governing BoardCombination of vasoconstrictorsInitial endoscopic hemostasisPatient's volume statusClinical Practice UpdateAcute Kidney Injury in Patients with Cirrhosis
Nadim M, Garcia-Tsao G. Acute Kidney Injury in Patients with Cirrhosis. New England Journal Of Medicine 2023, 388: 733-745. PMID: 36812435, DOI: 10.1056/nejmra2215289.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
2022
Prognosis of hospitalized patients with cirrhosis and acute kidney disease
Wong F, Garcia‐Tsao G, Reddy KR, O'Leary JG, Kamath PS, Tandon P, Lai JC, Vargas HE, Biggins SW, Fallon MB, Thuluvath PJ, Maliakkal BJ, Subramanian R, Thacker L, Bajaj JS. Prognosis of hospitalized patients with cirrhosis and acute kidney disease. Liver International 2022, 42: 896-904. PMID: 35023264, PMCID: PMC11075740, DOI: 10.1111/liv.15154.Peer-Reviewed Original ResearchConceptsAcute kidney diseaseStage 1 AKIAKD patientsPeak ScrAKI patientsCirrhotic patientsKidney diseaseSecond infectionEnd-stage liver diseaseDecompensated cirrhotic patientsHigher hospital admissionsWorse renal dysfunctionNormal renal functionGlomerular filtration rateNorth American ConsortiumBaseline SCrRenal dysfunctionPrompt treatmentRenal functionSerum creatinineHospital admissionClinical outcomesLiver diseasePredictive factorsFiltration rate
2021
Admission Urinary and Serum Metabolites Predict Renal Outcomes in Hospitalized Patients With Cirrhosis
Bajaj JS, Garcia‐Tsao G, Reddy KR, O’Leary J, Vargas HE, Lai JC, Kamath PS, Tandon P, Subramanian RM, Thuluvath P, Fagan A, Sehrawat T, de la Rosa Rodriguez R, Thacker LR, Wong F. Admission Urinary and Serum Metabolites Predict Renal Outcomes in Hospitalized Patients With Cirrhosis. Hepatology 2021, 74: 2699-2713. PMID: 34002868, PMCID: PMC9338693, DOI: 10.1002/hep.31907.Peer-Reviewed Original ResearchConceptsAcute kidney injuryPrediction of AKIClinical variablesSerum/urineSerum metabolitesBranched-chain amino acid metabolitesLiver disease centerNorth American ConsortiumRole of serumAmino acid metabolitesAdmission urinaryAKI developmentAKI subgroupCirrhosis cohortRenal outcomesRenoprotective measuresKidney injuryAKI predictionCirrhosis severityDialysis initiationHospitalized patientsPoor prognosisUrine metabolomicsEarly initiationSpecific admission
2020
Acute Kidney Injury in Decompensated Cirrhosis Is Associated With Both Hypo‐coagulable and Hyper‐coagulable Features
Zanetto A, Rinder HM, Campello E, Saggiorato G, Deng Y, Ciarleglio M, Wilson FP, Senzolo M, Gavasso S, Bulato C, Simioni P, Garcia‐Tsao G. Acute Kidney Injury in Decompensated Cirrhosis Is Associated With Both Hypo‐coagulable and Hyper‐coagulable Features. Hepatology 2020, 72: 1327-1340. PMID: 32614088, PMCID: PMC8672302, DOI: 10.1002/hep.31443.Peer-Reviewed Original ResearchConceptsAcute kidney injuryPlasmin-antiplasmin complexDecompensated cirrhosisHemostasis assessmentVon Willebrand factorKidney injuryPlatelet functionThrombin generationPlatelet aggregationSeverity of cirrhosisMedian serum creatinineWillebrand factorLower platelet aggregationAnti-coagulant factorsImpaired platelet functionAKI resolutionHypercoagulable featuresSerum creatinineAspects of hemostasisCirrhosis patientsPlatelet countProspective studyFibrinolytic factorsCirrhosisHyperfibrinolytic state
2019
Impact of Chronic Kidney Disease on Outcomes in Cirrhosis
Wong F, Reddy K, O’Leary J, Tandon P, Biggins SW, Garcia‐Tsao G, Maliakkal BJ, Lai JC, Fallon MB, Vargas HE, Subramanian R, Thuluvath PJ, Kamath PS, Thacker L, Bajaj JS. Impact of Chronic Kidney Disease on Outcomes in Cirrhosis. Liver Transplantation 2019, 25: 870-880. PMID: 30908855, PMCID: PMC11075743, DOI: 10.1002/lt.25454.Peer-Reviewed Original ResearchConceptsChronic kidney diseaseKidney diseasePrevalence of CKDEnd-stage liver diseaseHospital clinical courseAcute kidney injuryChild-Pugh scoreChronic liver failureHigher serum creatinineGlomerular filtration rateHigh-risk groupNorth American ConsortiumCKD groupHospital courseKidney injuryRefractory ascitesNegative patientsOverall survivalPositive patientsSerum creatinineCirrhosis etiologyClinical courseHospital admissionHospitalized patientsLiver failureOutcomes After Listing for Liver Transplant in Patients With Acute‐on‐Chronic Liver Failure: The Multicenter North American Consortium for the Study of End‐Stage Liver Disease Experience
O’Leary J, Bajaj JS, Tandon P, Biggins SW, Wong F, Kamath PS, Garcia‐Tsao G, Maliakkal B, Lai J, Fallon M, Vargas HE, Thuluvath P, Subramanian R, Thacker LR, Reddy K. Outcomes After Listing for Liver Transplant in Patients With Acute‐on‐Chronic Liver Failure: The Multicenter North American Consortium for the Study of End‐Stage Liver Disease Experience. Liver Transplantation 2019, 25: 571-579. PMID: 30724010, PMCID: PMC11075742, DOI: 10.1002/lt.25426.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryAcute-On-Chronic Liver FailureAdultDisease ProgressionEnd Stage Liver DiseaseFemaleHospital MortalityHospitalizationHumansLiver CirrhosisLiver TransplantationMaleMiddle AgedNorth AmericaProspective StudiesRenal DialysisSeverity of Illness IndexSurvival RateTime-to-TreatmentWaiting ListsConceptsChronic liver failureLiver transplantationNorth American ConsortiumLiver failureEnd-stage liver disease (MELD) scoreEnd-stage liver diseaseAmerican ConsortiumExtrahepatic organ failureAcute kidney injuryLiver Disease scoreOutcomes of patientsPost-LT survivalPerioperative dialysisRenal recoveryKidney injuryLiver transplantOrgan failureLiver diseaseMedian timeMedian MELDACLFSimilar survivalDisease experienceDisease scorePatients
2018
Acute kidney injury, but not sepsis, is associated with higher procedure‐related bleeding in patients with decompensated cirrhosis
Hung A, Garcia‐Tsao G. Acute kidney injury, but not sepsis, is associated with higher procedure‐related bleeding in patients with decompensated cirrhosis. Liver International 2018, 38: 1437-1441. PMID: 29393567, PMCID: PMC6072624, DOI: 10.1111/liv.13712.Peer-Reviewed Original ResearchConceptsAcute kidney injuryProcedure-related bleedingKidney injuryPost-procedure bleedingRisk factorsCT scanEnd-stage renal diseaseInfection/sepsisAbnormal coagulation parametersBlood product transfusionLarge-volume paracentesisNon-cirrhotic patientsRetrospective chart reviewOnly independent predictorUnstratified cohortsMELD scoreProduct transfusionAdverse eventsChart reviewPatient characteristicsCirrhosis patientsIndependent predictorsRenal diseaseHemoglobin levelsCoagulation parameters
2017
Acute Kidney Injury in Cirrhosis: Baseline Serum Creatinine Predicts Patient Outcomes
Wong F, O'Leary J, Reddy K, Garcia-Tsao G, Fallon M, Biggins S, Subramanian R, Thuluvath P, Kamath P, Patton H, Maliakkal B, Tandon P, Vargas H, Thacker L, Bajaj J. Acute Kidney Injury in Cirrhosis: Baseline Serum Creatinine Predicts Patient Outcomes. The American Journal Of Gastroenterology 2017, 112: 1103. PMID: 28440305, DOI: 10.1038/ajg.2017.122.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryBiomarkersCreatinineFemaleHumansLiver CirrhosisMaleMiddle AgedRisk FactorsSensitivity and SpecificitySurvival RateConceptsAcute kidney injuryBaseline serum creatinineHigher baseline serum creatinineInternational Ascites ClubSerum creatinineDelta serum creatinineAKI outcomesKidney injuryPatient outcomesDevelopment of AKIIncidence of AKIStage 1 acute kidney injuryTertiary-care hepatology centersEnd-stage liver diseaseBaseline SCr levelPeak serum creatinineMultivariate logistic regressionNorth American ConsortiumAKI episodesAKI progressionAKI riskCirrhotic inpatientsHepatology centersCirrhotic patientsSCr levels
2014
Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury
Belcher JM, Sanyal AJ, Peixoto AJ, Perazella MA, Lim J, Thiessen‐Philbrook H, Ansari N, Coca SG, Garcia‐Tsao G, Parikh CR, Consortium F. Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury. Hepatology 2014, 60: 622-632. PMID: 24375576, PMCID: PMC4065642, DOI: 10.1002/hep.26980.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryAcute-Phase ProteinsAdultAgedAlbuminuriaBiomarkersCreatinineDiagnosis, DifferentialFatty Acid-Binding ProteinsFemaleGlomerular Filtration RateHepatitis A Virus Cellular Receptor 1HumansInterleukin-18KidneyLipocalin-2LipocalinsLiver CirrhosisMaleMembrane GlycoproteinsMiddle AgedProspective StudiesProto-Oncogene ProteinsReceptors, VirusSodiumConceptsAcute kidney injuryAcute tubular necrosisKidney injury molecule-1Neutrophil gelatinase-associated lipocalinHepatorenal syndromePrerenal azotemiaKidney injuryDifferential diagnosisUrinary biomarkersEtiology of AKIProgressive acute kidney injuryLiver-type fatty acidOptimal diagnostic cutoffInjury molecule-1Prospective cohort studyGelatinase-associated lipocalinAccurate differential diagnosisClinical decision makingNumber of biomarkersCohort studyTubular necrosisFractional excretionCommon etiologyInterleukin-18Kidney biomarkers
2013
New Consensus Definition of Acute Kidney Injury Accurately Predicts 30-Day Mortality in Patients With Cirrhosis and Infection
Wong F, O'Leary JG, Reddy KR, Patton H, Kamath PS, Fallon MB, Garcia–Tsao G, Subramanian RM, Malik R, Maliakkal B, Thacker LR, Bajaj JS, Disease N. New Consensus Definition of Acute Kidney Injury Accurately Predicts 30-Day Mortality in Patients With Cirrhosis and Infection. Gastroenterology 2013, 145: 1280-1288.e1. PMID: 23999172, PMCID: PMC4418483, DOI: 10.1053/j.gastro.2013.08.051.Peer-Reviewed Original ResearchConceptsAcute kidney injuryDays of hospitalizationKidney injuryOrgan failureConsensus definitionHigher Child-Pugh scoreIrreversible acute kidney injuryChild-Pugh scoreHigh MELD scoreSerum creatinine levelsMean arterial pressureIntensive care unitLength of stayNew consensus definitionStable baseline valuesAKI episodesRenal recoveryHospital stayMELD scoreCreatinine levelsArterial pressureCare unitProspective studyBaseline valuesConsensus conferenceAcute Kidney Injury in Patients With Cirrhosis: Perils and Promise
Belcher JM, Parikh CR, Garcia–Tsao G. Acute Kidney Injury in Patients With Cirrhosis: Perils and Promise. Clinical Gastroenterology And Hepatology 2013, 11: 1550-1558. PMID: 23583467, PMCID: PMC3840046, DOI: 10.1016/j.cgh.2013.03.018.Commentaries, Editorials and LettersMeSH KeywordsAcute Kidney InjuryAlcoholismBilirubinBiomarkersCreatinineHepatitis C, ChronicHumansLiver CirrhosisMaleMiddle AgedSodiumConceptsCreatinine levelsSodium levelsRenal Disease Study equationPacked red blood cellsTotal serum bilirubin levelsAcute kidney injurySerum creatinine levelsMental status changesRenal tubular epithelial cellsSerum sodium levelsChronic liver diseaseGlomerular filtration rateInternational normalization ratioModification of DietIntensive care unitUrine sodium levelSerum bilirubin levelsFresh frozen plasmaChronic alcohol abuseTubular epithelial cellsHepatitis CKidney injuryRed blood cellsBlood pressureFractional excretion
2012
Association of AKI With mortality and complications in hospitalized patients with cirrhosis
Belcher JM, Garcia‐Tsao G, Sanyal AJ, Bhogal H, Lim JK, Ansari N, Coca SG, Parikh CR, Consortium F. Association of AKI With mortality and complications in hospitalized patients with cirrhosis. Hepatology 2012, 57: 753-762. PMID: 22454364, PMCID: PMC3390443, DOI: 10.1002/hep.25735.Peer-Reviewed Original ResearchConceptsAcute kidney injuryAcute Kidney Injury Network definitionAssociation of AKIDefinition of AKISeverity of AKIProgression of AKIProspective observational cohort studyAKIN stage 1Baseline renal functionObservational cohort studyIncidence of mortalityAKI criteriaAKI severityAKI stageAKIN criteriaAKIN stageHospital mortalityKidney injuryCohort studyDevastating complicationRenal functionHospitalized patientsImproved outcomesEarly diagnosisTimely treatment
2010
Renal Dysfunction Is the Most Important Independent Predictor of Mortality in Cirrhotic Patients With Spontaneous Bacterial Peritonitis
Tandon P, Garcia–Tsao G. Renal Dysfunction Is the Most Important Independent Predictor of Mortality in Cirrhotic Patients With Spontaneous Bacterial Peritonitis. Clinical Gastroenterology And Hepatology 2010, 9: 260-265. PMID: 21145427, PMCID: PMC3713475, DOI: 10.1016/j.cgh.2010.11.038.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryBacterial InfectionsFemaleHumansLiver CirrhosisMaleMiddle AgedPeritonitisPrognosisConceptsRenal dysfunctionCirrhotic patientsBacterial peritonitisAscitic fluid cell countHigh-risk patientsMain prognostic factorsNormal renal functionSpontaneous bacterial peritonitisHigh-risk groupImportant independent predictorBlood urea nitrogenGood quality studiesSBP resolutionVasoconstrictor therapyMELD scoreAdult patientsRenal functionIndependent predictorsMedian agePrognostic factorsRisk stratificationCommon infectionsImmunosuppressive factorsPrognostic valuePrognostic studies
2008
Acute kidney injury in cirrhosis
Garcia‐Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology 2008, 48: 2064-2077. PMID: 19003880, DOI: 10.1002/hep.22605.Peer-Reviewed Original ResearchConceptsAcute kidney injuryAcute renal failureHepatorenal syndromeKidney injurySerum creatinineSpecific therapyEffective arterial blood volumeUseful bridging therapyAcute tubular necrosisRenal blood flowSpontaneous bacterial peritonitisArterial blood volumeBridging therapyLiver transplantationPrerenal azotemiaRenal dysfunctionRenal failureTubular necrosisBacterial peritonitisVasodilatory stateRelative hypovolemiaVolume repletionCommon causeCirrhosisBlood flow