The latest International Club of Ascites (ICA) recommendations eliminate a set serum creatinine (SCr) threshold for diagnosis-which means you can intervene in hepatorenal syndrome type 1 (HRS-1) earlier.1

And recent data show that earlier intervention may lead to better outcomes for HRS-1 patients.1

Subtle serum creatinine changes are
a reliable predictor of HRS-1 mortality

Recent evidence suggests that subtle changes in serum creatinine (SCr) levels are prognostic indicators of patient outcomes. Prompt identification of patients at risk for HRS-1 can increase the likelihood of positive treatment outcomes.2,3

An SCr increase of 0.3 mg/dL within the first 48 hours of hospitalization was shown to be the best predictor
of mortality risk among patients with cirrhosis.2,3

See the impact on clinical practice

Removal of a set serum creatinine
threshold promotes earlier intervention

The latest International Club of Ascites (ICA) consensus recommendations (2015) promote close monitoring of patients’ serum creatinine (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 ≥1.5 mg/dL.1

Breaking down the 2015 ICA consensus
recommendations in the context of HRS-1

The 2015 ICA consensus recommendations for SCr assessments are:

Measurement of SCr against a baseline:
increase in SCr ≥0.3 mg/dL within 48 hours,1

or

A percentage increase in SCr ≥50% from baseline, which is
known or presumed to have occurred within the prior 7 days.1

Staging of acute kidney injury

An SCr value from the previous 3 months can be used as baseline.
In patients where more than one SCr value is available, the value closest
to hospital admission should be used.1

Stage 1
Increase in SCr ≥0.3 mg/dL (26.5 μmol/L) or an increase in SCr ≥1.5-fold to 2-fold from baseline1

Stage 2
Increase in SCr >2-fold to 3-fold from baseline1

Stage 3
Increase of SCr >3-fold from baseline or SCr ≥4.0 mg/dL (353.6 μmol/L) with an acute increase ≥0.3 mg/dL (26.5 μmol/L) or initiation of renal replacement therapy1

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and Treatment Algorithm

For management of HRS-1, the guidelines recommend
initiating vasoconstrictor therapy plus albumin if patients:

  • Demonstrate an increase in SCr >2-fold to 3-fold from baseline1
  • Meet the other criteria for HRS-1 diagnosis1

Earlier intervention may lead
to better outcomes

Intervening in HRS-1 according to the 2015 International Club of Ascites (ICA) consensus recommendations was shown to help improve outcomes for HRS-1 patients. Earlier diagnosis leads to earlier intervention, and as the data show: earlier intervention may lead to better outcomes.4

The application of the
2015 ICA guidelines enabled:

  • Earlier treatment by approximately 4 days4
  • Initiation of treatment when serum creatinine (SCr) levels were, on average, approximately 1 mg/dL lower4
  • Treatment before a further ≥1.5-fold increase in SCr (in 47% of patients)4

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    Reference:

  • Angeli P, Ginès P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut. 2015;64(4):531-537.

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