{
  "abstract": "Background The prevalence of chronic kidney disease (CKD), defined as a glomerular filtration rate (GFR) of <60 mL/min/1.73 m 2 for >3 months, is rising in the global population.Objective To assess the global prevalence of CKD in cirrhosis and how it impacts the prognosis of these patients.Design The Chronic Liver Disease Evolution and Registry for Events and Decompensation consortium prospectively enrolled non-electively admitted cirrhosis patients from 127 sites globally, each with up to 100 patients. Data collected were demographics, comorbid conditions, cirrhosis history, hospital course and patient outcomes. Patients were divided into those with (CKD+) and without CKD (CKD–) and compared. We also compared patients from different World Bank income strata.Results Of 7040 inpatients enrolled, the global prevalence of CKD was 18.17%, with the highest prevalence observed in high-income countries (HICs), which paralleled their higher prevalence of metabolic syndrome. CKD+ patients had lower median enrolment GFR (32 (21, 44) mL/min/1.73 m 2) when compared with CKD– patients (88 (63, 117) mL/min/1.73 m2, p<0.0001), associated with a more complex history of cirrhosis complications, with ascites occurring in 76.5% of CKD+ versus 61.1% of patients with CKD- (p<0.0001). The most common in-hospital complication was the development of AKI (59.4%) in CKD+ versus 27% in CKD– patients (p<0.0001). CKD was associated with higher in-hospital and 30-day postdischarge mortality (both p<0.0001).Conclusions The presence of CKD negatively impacts the prognosis of admitted patients with cirrhosis in a global cohort. Meticulous management of ascites and lifestyle changes, especially in HICs, may improve the outcome of these patients.",
  "authors": [
    {
      "affiliations": [
        "Medicine, University Health Network, Toronto, Ontario, Canada"
      ],
      "name": "Florence Wong"
    },
    {
      "affiliations": [
        "Royal Berkshire NHS Foundation Trust, Reading, UK"
      ],
      "name": "Danielle Adebayo"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Sydney, Westmead, New South Wales, Australia"
      ],
      "name": "Jacob George"
    },
    {
      "affiliations": [
        "Gastroenterology, Ankara University School of Medicine, Ankara, Turkey"
      ],
      "name": "Ramazan Idilman"
    },
    {
      "affiliations": [
        "Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK"
      ],
      "name": "Peter C Hayes"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, Hospital de Clinicas de Porto Allegre, Porto Alegre, Brazil"
      ],
      "name": "Mario R Alvares-da-Silva"
    },
    {
      "affiliations": [
        "Gastroenterología, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico"
      ],
      "name": "Aldo Torre"
    },
    {
      "affiliations": [
        "St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia"
      ],
      "name": "Hailemichael Desalgn Mekonnen"
    },
    {
      "affiliations": [
        "Medicine, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Wai-Kay Seto"
    },
    {
      "affiliations": [
        "Hepatology, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India"
      ],
      "name": "Shiv Kumar Sarin"
    },
    {
      "affiliations": [
        "Department of Infectious Disease, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China"
      ],
      "name": "Zhujun Cao"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, Birmingham, UK"
      ],
      "name": "Neil Rajoriya"
    },
    {
      "affiliations": [
        "Jaslok Hospital, Mumbai, India"
      ],
      "name": "Aabha Nagral"
    },
    {
      "affiliations": [
        "St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia"
      ],
      "name": "Henok Fisseha"
    },
    {
      "affiliations": [
        "Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India"
      ],
      "name": "Anand V Kulkarni"
    },
    {
      "affiliations": [
        "Department of Hepatology, The Fifth People’s Hospital of Suzhou, Nanjing, China"
      ],
      "name": "Chuanwu Zhu"
    },
    {
      "affiliations": [
        "Mustapha University Hospital Center, Algiers, Algeria"
      ],
      "name": "Nabil Debzi"
    },
    {
      "affiliations": [
        "Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil"
      ],
      "name": "Alberto Queiroz Farias"
    },
    {
      "affiliations": [
        "First Affiliated Hospital of Guangxi Medical University, Nanning, China"
      ],
      "name": "Minghua Su"
    },
    {
      "affiliations": [
        "Christian Medical College Vellore, Vellore, India"
      ],
      "name": "Ashish Goel"
    },
    {
      "affiliations": [
        "Hospital Italiano de Buenos Aires, Buenos Aires, Argentina"
      ],
      "name": "Sebastián Marciano"
    },
    {
      "affiliations": [
        "Royal Berkshire NHS Foundation Trust, Reading, UK"
      ],
      "name": "Robert Livingstone"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"
      ],
      "name": "Radha Krishan Dhiman"
    },
    {
      "affiliations": [
        "Department of Hepatology, First Affiliated Hosptial of Jilin University, Changchun, Jilin, China"
      ],
      "name": "Yanhang Gao"
    },
    {
      "affiliations": [
        "Instituto de Salud Digestiva y Hepática, Guadalajara, Mexico"
      ],
      "name": "René Malé-Velázquez"
    },
    {
      "affiliations": [
        "Marmara University, Istanbul, Turkey"
      ],
      "name": "Coskun Ozer Demitars"
    },
    {
      "affiliations": [
        "Medicine, University Health Network, Toronto, Ontario, Canada"
      ],
      "name": "Chinmay Bera"
    },
    {
      "affiliations": [
        "The Second Xiangya Hospital of Central South University, Changsha, Hunan, China"
      ],
      "name": "Yong-Fang Jiang"
    },
    {
      "affiliations": [
        "Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Mexico"
      ],
      "name": "Jose Antonio Velarde-Ruiz Velasco"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology, Singapore General Hospital, Singapore"
      ],
      "name": "Hiang Keat Tan"
    },
    {
      "affiliations": [
        "The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"
      ],
      "name": "Caiyan Zhao"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Centro Médico, ISSEMYM, Toluca, Mexico"
      ],
      "name": "Maria Sarai Gonzalez Huezo"
    },
    {
      "affiliations": [
        "Baylor University Medical Center, Dallas, Texas, USA"
      ],
      "name": "Sumeet K Asrani"
    },
    {
      "affiliations": [
        "The Second Hospital of Shandong University, Jinan, Shandong, China"
      ],
      "name": "Lei Wang"
    },
    {
      "affiliations": [
        "The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China"
      ],
      "name": "Mingqin Lu"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, Hospital de Clinicas de Porto Allegre, Porto Alegre, Brazil"
      ],
      "name": "Matheus Truccolo Michalczuk"
    },
    {
      "affiliations": [
        "Gaziantep University Faculty of Medicine, Gaziantep, Turkey"
      ],
      "name": "Sezgin Barutcu"
    },
    {
      "affiliations": [
        "Hospital General Dr Manuel Gea Gonzalez, Mexico, Mexico"
      ],
      "name": "Jacqueline Cordova-Gallardo"
    },
    {
      "affiliations": [
        "Royal North Shore Hospital, St Leonards, New South Wales, Australia"
      ],
      "name": "Cameron Gofton"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Sydney, Westmead, New South Wales, Australia"
      ],
      "name": "Michael Gounder"
    },
    {
      "affiliations": [
        "Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VAMC, Richmond, Virginia, USA"
      ],
      "name": "Jawaid Shaw"
    },
    {
      "affiliations": [
        "Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VAMC, Richmond, Virginia, USA"
      ],
      "name": "Somaya Albhaisi"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Huazhong University of Science and Technology, Wuhan, China"
      ],
      "name": "Xin Zheng"
    },
    {
      "affiliations": [
        "University of Nottingham, Nottingham, UK"
      ],
      "name": "Aloysious Aravinthan"
    },
    {
      "affiliations": [
        "Department of Medicine, Gastroenterology and Hepatology Unit, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia"
      ],
      "name": "Ruveena Bhavani Rajaram"
    },
    {
      "affiliations": [
        "Institute of Liver Disease & Transplantation, Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Rsearch, Chennai, India"
      ],
      "name": "Dinesh Jothimani"
    },
    {
      "affiliations": [
        "Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand"
      ],
      "name": "Kessarin Thanapirom"
    },
    {
      "affiliations": [
        "Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile"
      ],
      "name": "Carlos Benitez"
    },
    {
      "affiliations": [
        "Akdeniz University Faculty of Medicine, Antalya, Turkey"
      ],
      "name": "Dinc Dincer"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India"
      ],
      "name": "Anoop Saraya"
    },
    {
      "affiliations": [
        "Beijing Youan Hoapital, Capital Medical University, Hepatology, China"
      ],
      "name": "Bin Xu"
    },
    {
      "affiliations": [
        "Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China"
      ],
      "name": "Minghua Lin"
    },
    {
      "affiliations": [
        "The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China"
      ],
      "name": "Xiaoping Wu"
    },
    {
      "affiliations": [
        "Institute of Liver Diseases, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China"
      ],
      "name": "Chenghai Liu"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology, Penn Medicine, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Rajender Reddy"
    },
    {
      "affiliations": [
        "Biostatistics, Virginia Commonwealth University and McGuire VAMC, Richmond, Virginia, USA"
      ],
      "name": "Brian Bush"
    },
    {
      "affiliations": [
        "Biostatistics, Virginia Commonwealth University and McGuire VAMC, Richmond, Virginia, USA"
      ],
      "name": "Leroy R Thacker"
    },
    {
      "affiliations": [
        "St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia"
      ],
      "name": "Mark Topazian"
    },
    {
      "affiliations": [
        "Department of Infectious Disease, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China"
      ],
      "name": "Qing Xie"
    },
    {
      "affiliations": [
        "Biostatistics, Virginia Commonwealth University and McGuire VAMC, Richmond, Virginia, USA"
      ],
      "name": "Scott Silvey"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology, Mayo Medical School, Rochester, Minnesota, USA"
      ],
      "name": "Patrick S Kamath"
    },
    {
      "affiliations": [
        "Hepatology, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India"
      ],
      "name": "Ashok Choudhury"
    },
    {
      "affiliations": [
        "Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VAMC, Richmond, Virginia, USA"
      ],
      "name": "Jasmohan S Bajaj"
    },
    {
      "affiliations": [],
      "name": "on behalf of CLEARED Investigators"
    }
  ],
  "title": "Chronic kidney disease in cirrhosis: a study of inpatients from a global perspective",
  "uid": "a0ce39b1-223c-5da9-8d26-fb550d44df57"
}