S2623 Racial Disparities in Hepatorenal Syndrome Incidence and Outcomes Among Cirrhotic Patients: Insights From a Large Retrospective Cohort Study

Introduction: Hepatorenal syndrome (HRS) represents a life-threatening complication in cirrhosis, with significant racial disparities in incidence and outcomes. Black and Native American patients face disproportionate barriers to advanced liver care, contributing to suboptimal outcomes. This study investigates racial and ethnic disparities in HRS among cirrhotic patients, aiming to identify contributing factors and underscore the need for targeted interventions to improve equity in healthcare delivery. Methods: Using the TriNetX database, we conducted a retrospective analysis of 34,885 cirrhotic patients diagnosed with HRS between 2000 and 2024. Patients were stratified by race/ethnicity (American Indian or Alaska Native, Asian, Black, Native Hawaiian or Other Pacific Islander, White, and Other). HRS incidence was calculated as the proportion of new cases among cirrhotic patients. Chi-square tests were employed to examine racial disparities, adjusting for confounders such as age, sex, and liver disease severity. Mortality and survival data from existing literature provided contextual insights into outcome disparities. Results: Among cirrhotic patients, 5.6% developed HRS, with the highest incidence observed in American Indian or Alaska Native patients (9.35%), followed by White (6.10%) and Other Race (6.21%) groups. Black and American Indian patients exhibited disproportionately poor survival rates post-HRS diagnosis (P < 0.05), even after controlling for age and comorbid conditions, reflecting systemic barriers, including reduced access to nephrology care and renal replacement therapies. Socioeconomic challenges and healthcare inequities were identified as key contributors to these disparities. Conclusion: This study highlights stark racial disparities in the incidence and outcomes of HRS among cirrhotic patients, emphasizing the disproportionate burden on American Indian and Black populations. Addressing these inequities requires systemic reforms to improve early detection, expand access to renal replacement therapies, and mitigate socioeconomic barriers. These findings underscore the critical need for equity-focused interventions to enhance care delivery and outcomes for marginalized populations.