Determinants of Acute Kidney Injury After Endoscopic Retrograde Cholangiopancreatography in Patients With Liver Cirrhosis: Retrospective Observational Study.

BACKGROUND

Patients with cirrhosis may have acute kidney injury (AKI) after receiving endoscopic retrograde cholangiopancreatography (ERCP).

OBJECTIVE

This study aimed to identify determinants of AKI that require dialysis following ERCP in patients with cirrhosis.

METHODS

Data from the US Nationwide Inpatient Sample from 2016 to 2020 were retrospectively reviewed. Patients aged ≥20 years with liver cirrhosis who underwent ERCP were identified. The primary outcome was AKI requiring dialysis. Logistic regression with stepwise selection was used to identify factors associated with dialysis-requiring AKI among demographic variables, comorbidities, and hospital characteristics.

RESULTS

Data from 6748 patients with liver cirrhosis who underwent ERCP were analyzed, and 2.2% (n=148) developed AKI that required dialysis. After adjustment, the results showed that decompensated liver cirrhosis (adjusted odds ratio [aOR] 4.73, 95% CI 3.12-7.15; P<.001), chronic kidney disease (aOR 5.93, 95% CI 4.00-8.79; P<.001), obesity (aOR 1.65, 95% CI 1.05-2.59; P=.03), and sepsis (aOR 3.57, 95% CI 2.44-5.23; P<.001) were significant factors associated with AKI that required dialysis. The developed model demonstrated good calibration and discrimination (c-index: 0.826 for derivation cohort, 0.824 for validation cohort).

CONCLUSIONS

Decompensated liver cirrhosis, preexisting chronic kidney disease, obesity, and sepsis are significant factors associated with AKI that require dialysis following ERCP in patients with liver cirrhosis. These findings can inform risk stratification and management strategies to improve outcomes in this high-risk population.