Comparing Clinical Presentation and Spectrum of Acute Kidney Injury in Patients with Alcohol-Related and Non-Alcoholic Steatohepatitis-Related Chronic Liver Disease

Background: Acute kidney injury (AKI) is a frequent and serious complication among patients with chronic liver disease (CLD), significantly impacting morbidity and mortality rates. Despite the rising prevalence of both alcohol-related CLD and non-alcoholic steatohepatitis (NASH)-related CLD globally, comparative data on the clinical presentation and spectrum of AKI in these patient populations are limited. Methods: In this cross-sectional study, we analysed 720 patients diagnosed with CLD at our tertiary care centre from January 2023 to June 2024. Patients were categorized into two groups: 360 with alcohol-related CLD and 360 with NASH-related CLD. AKI was identified and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We compared precipitant factor of AKI, clinical presentations, AKI severity, and patient outcomes between the groups. Results: AKI was present in 47.5% (171/360) of patients with alcohol-related CLD and 45.8% (165/360) of patients with NASH-related CLD (p=0.65). Common precipitating factors for AKI in ArLD & NASH group were sepsis (69 & 33, p<0.04), UTI (39 & 15, p<0.04), GI bleeding (21 & 51 p<0.04), SBP (21 & 18 NS), GI loss (6 & 9 NS), diuretic overdose (3 & 3 NS). HRS was more common in NASH group compared to ArLD (30 & 9 p<0.05). Clinical presentation as ACLF was more common in ArLD (45 & 18 p<0.03) whereas GI bleeding was more in NASH group (51 &21, p<0.01). In-hospital mortality was significantly higher in patients with alcohol-related CLD and AKI (28%) compared to those with NASH-related CLD and AKI (18%) (p=0.04). Conclusion: AKI is equally prevalent in ArLD & NASH related CLD. Infections (sepsis & UTI) are common precipitating factor in ArLD whereas GI bleeding is common precipitant in NASH related CLD. HRS is more likely in NASH compared to ArLD.