Primary prevention

HRS-AKI can be prevented by preventing the development of AKI in patients with cirrhosis. Methods of primary prevention include:[21]

  • Avoidance of nephrotoxic drugs such as non-steroidal anti-inflammatory drugs (NSAIDs)

  • Avoidance of excessive or unmonitored diuretics or non-selective beta-blockers

  • Avoidance of large-volume paracentesis without intravenous albumin replacement

  • Administration of intravenous albumin in addition to antibiotic treatment in the setting of spontaneous bacterial peritonitis (SBP)

  • Prevention strategies aimed at counselling patients to avoid alcohol use.

HRS-AKI can be prevented in patients with cirrhosis in two specific clinical settings: SBP and large volume paracentesis.[20]

In patients with SBP, treatment with albumin and antibiotics reduces the incidence of renal impairment and death.[2][22][23]​​ Post-paracentesis circulatory dysfunction, which occurs after large volume paracenteses (greater than or equal to 5 L) can be prevented by administering up to 6 to 8 g of albumin for each litre drained, decreasing the risk of HRS-AKI.[24][25]​​​

One randomised controlled trial comprising 174 patients with severe alcohol-related hepatitis reported less frequent HRS-related deaths in patients treated with prednisolone plus acetylcysteine compared with those treated with prednisolone alone.[26]

Secondary prevention

It is important that patients are immunised against influenza, COVID-19, and pneumococcal disease, as they are immunocompromised.

Use of this content is subject to our disclaimer