Author information

¹Division of Nephrology and Hypertension, Keck School of Medicine, University of Southern California, Los Angeles, USA.

²Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA, USA.

³School of Medicine, University of Surrey and Critical Care Unit, Royal Surrey Hospital Guildford UK.

⁴Hepatology & Liver Intensive Care, Hospital Beaujon, Clichy, Paris, France.

⁵Baylor University Medical Center, Dallas, Texas, USA.

⁶King's College London, Guy's & St Thomas' Hospital, Department of Critical Care, London, UK.

⁷Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.

⁸Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.

⁹Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

¹⁰Unit of Internal Medicine and Hepatology, Department of Medicine - DIMED, University and Hospital of Padova, Padova, Italy.

¹¹Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

¹²Division of Digestive and Liver Diseases, Columbia University, New York, NY, USA.

¹³Department of Pediatrics, Divisions of Critical Care Medicine and Nephrology, Baylor College of Medicine, Houston, TX, USA.

¹⁴Unit of Internal Medicine and Hepatology, University and Teaching Hospital of Padua, Italy.

¹⁵Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA.

¹⁶Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

¹⁷Pediatric Intensive Care Unit, King's College Hospital, London, UK.

¹⁸Digestive Diseases Section, Yale University School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA.

¹⁹Division of Abdominal Organ transplantation and Hepatobiliary Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Abdominal Organ Transplantation at Children's Hospital of Los Angeles, Los Angeles, CA, USA.

²⁰Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi-Sunyer and Ciber de Enfermedades Hepàticas y Digestivas, Barcelona, Catalonia.

²¹Division of Gastroenterology and Hepatology Mayo Clinic College of Medicine and Science, Rochester, MN, USA.

²²Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA.

²³Department of Renal Medicine, Singapore General Hospital, Singapore.

²⁴Excellence Centre in Critical Care Nephrology and Division of Nephrology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

²⁵Division of Nephrology, Department of Medicine, University of California San Diego, CA, USA.

²⁶Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.

²⁷Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

²⁸Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA.

²⁹International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza-Italy.

³⁰Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.

³¹Department of Nephrology, Ochsner Health, New Orleans, LA, USA; Ochsner Clinical School, The University of Queensland, Brisbane, QLD, Australia.

³²Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, USA.

³³Hepatology & Liver Intensive Care, Hospital Beaujon, Clichy, Paris, France; University Paris Cité, Paris, France. Electronic address: francois.durand@bjn.aphp.fr.

Abstract

Patients with cirrhosis are prone to develop acute kidney injury (AKI), a complication associated with a markedly increased in-hospital morbidity and mortality, along with a risk of progression to chronic kidney disease. Whereas patients with cirrhosis are at increased risk of developing any phenotype of AKI, hepatorenal syndrome (HRS), a specific form of AKI (HRS-AKI) in patients with advanced cirrhosis and ascites, carries an especially high mortality risk. Early recognition of HRS-AKI is crucial since administration of splanchnic vasoconstrictors may reverse the AKI and serve as a bridge to liver transplantation, the only curative option. In 2023, a joint meeting of the International Club of Ascites (ICA) and the Acute Disease Quality Initiative (ADQI) was convened to develop new diagnostic criteria for HRS-AKI, to provide graded recommendations for the work-up, management and post-discharge follow-up of patients with cirrhosis and AKI, and to highlight priorities for further research.