Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites

Acute renal failure (ARF) is a common complication in patients with decompensated cirrhosis. The traditional diagnostic criteria of renal failure in these patients were proposed in 1996 and have been refined in subsequent years. According to these criteria, ARF is defined as an increase in serum creatinine (sCr) of >/= 50% from baseline to a final value >1.5 mg/dl (133 umol/L). However, the threshold value of 1.5 mg/dl (133umol/L) sCr to define renal failure in patients with decompensated cirrhosis has been challenged. In addition, the timeframe to distinguish acute from chronic renal failure has not been clearly identified, the only exception being type 1 hepatorenal syndrome (HRS). Meanwhile, new definitions for ARF, now termed acute kidney injury (AKI), have been proposed and validated in patients without cirrhosis. Recently these new criteria were also proposed and applied in the diagnosis of AKI in patients with cirrhosis. Thus, in December 2012, the International Club of Ascites (ICA) organised a consensus development meeting in Venice, Italy, in order to reach a new definition of AKI in patients with cirrhosis. The discussion among the experts continued thereafter for 2 years, both online and through several meetings, between those experts who had different positions on crucial points on the subject. This paper reports the scientific evidence supporting the final proposal of a new approach to the diagnosis and treatment of this condition, on which the experts agreed.