The American Association for the Study of Liver Diseases (AASLD) has updated their Guidance with a key recommendation: elimination of an absolute serum creatinine (SCr) threshold for diagnosis of hepatorenal syndrome acute kidney injury (HRS-AKI / HRS-1). This Guidance, which aligns with a 2015 recommendation from the International Club of Ascites (ICA), may lead to earlier diagnosis and improved treatment outcomes.1-3
HRS-AKI / HRS-1:
New AASLD nomenclature and definition
Kidney Injury Definition
Previously known as
HRS-1:Doubling of SCr to a value >2.5 mg/dL within 2 weeks4
Now known as
HRS-AKI:Increase in SCr of ≥0.3 mg/dL within 48 hours1
or
Percent increase in SCr that is ≥50% of what was known or presumed to have occurred within the prior 7 days1
Removal of an absolute SCr threshold
promotes earlier intervention
The 2021 AASLD Guidance advocates close monitoring of patients' SCr levels and tracking subtle changes from baseline to determine the appropriate intervention.1
This recommendation is based on the latest KDIGO/AKIN criteria for diagnosis of kidney injury and is a change from prior guidelines that recommended initiating differential diagnosis at an absolute SCr threshold of >2.5 mg/dL.1,4
Highlights of the new 2021 AASLD Guidance in
the context of HRS-AKI / HRS-1
The 2021 AASLD Guidance recommendations for assessment are:
Increase in SCr ≥0.3 mg/dL within 48 hours1
or
Percent increase in SCr that is ≥50% of what was known or
presumed to have occurred within the prior 7 days1
For management of HRS-AKI / HRS-1, the 2021 AASLD Guidance recommends
initiating vasoconstrictor therapy plus albumin if patients:
- Demonstrate an increase in SCr >2-fold from baseline1
- Meet the other criteria for HRS-AKI / HRS-1 diagnosis1