Royal Free Hospital‐estimated glomerular filtration rate for prognostic stratification of first acute kidney injury in cirrhosis

Background & Aims Renal function is a major determinant of prognosis in patients with cirrhosis. Current guidelines only contemplate serum creatinine (sCr) to assess kidney injury. However, there are formulas to estimate glomerular filtration rate (eGFR) which better measure renal function in patients listed for liver transplantation. There is no data available on whether these formulas predict prognosis in patients with acute kidney injury (AKI). Methods In 143 patients presenting with a first episode of AKI, we compared the prognostic value of renal function estimated using sCr or eGFR assessed with Modification of Diet in Renal Disease (MDRD‐6), chronic kidney disease epidemiology (CKD‐EPI) and Royal Free Hospital (RFH) for renal replacement therapy (RRT) within 30 days of AKI, and 30‐ and 90‐day transplant‐free survival. Results eGFR was calculated on values obtained before and at admission, at presentation of AKI (D0) and 48 hours after AKI (D2).15% of patients (more commonly in alcohol + metabolic etiology; P = .049 vs other) required RRT. Transplant‐free survival at 30‐and 90‐day were 77% and 63%. Among sCr, MDRD‐6, CKD‐EPI and RFH‐eGFR, the latter predicted best RRT (HR 0.937 95% CI 0.893‐0.982, P = .007), 30‐d (HR 0.936 95% CI 0.901‐0.972, P = .001) and 90‐d (HR 0.934 95% CI 0.908‐0.972, P