Can AKI HRS be prevented
Are there any scenarios in which AKI HRS can be prevented?
One-third of patients with SBP will develop kidney impairment despite appropriate antibiotic therapy. Patients who receive albumin in addition to antibiotics have been shown to have a lower incidence of kidney impairment and death compared to those treated with antibiotics alone. The benefit was particularly marked in patients with an elevated baseline creatinine >1 mg/dL (88 μmol/L) and/or bilirubin >4 mg/dL (68 μmol/L). Patients in this study received intravenous albumin at a dose of 1.5 g/kg body weight on day 1, then 1 g/kg body weight on day 3.
• Although antibiotics alone have not been shown to directly reduce the incidence of AKI-HRS, primary prophylaxis of SBP with norfloxacin reduces the incidence of SBP, which is a risk factor for AKI-HRS.
Removal of large (≥5 liters) amounts of ascites may precipitate post-paracentesis circulatory dysfunction, which can induce kidney failure in up to 20% of patients. Giving albumin at a dose of 6 to 8 g/L of ascitic fluid removed has been shown to reduce the incidence of kidney failure but not mortality.
Prophylactic antibiotics given to patients with gastrointestinal bleeds for a duration of 7 days have been shown to reduce the incidence of SBP, which is a recognized risk factor for AKI-HRS, especially in Child-Pugh Classes B and C patients.