Burden and impact of acute kidney injury in acute liver failure: A systematic review

BACKGROUND: Acute kidney injury (AKI) affects 40%-80% of patients with acute liver failure (ALF) and arises from complex mechanisms, including hemodynamic instability, drug toxicity, and direct renal insults. Unlike chronic liver disease, AKI in ALF is poorly studied. AIM: To consolidate current evidence and guide future research and interventions to improve outcomes in ALF patients with AKI. METHODS: This systematic review followed PRISMA guidelines, searching databases from 2000 to 2024 for studies on AKI in ALF. We included studies focused on adult, English-language, full-length epidemiological studies. Data were extracted on study design, patient demographics, risk factors, and outcomes. Methodological quality was assessed using a tailored 5-point tool. Data were summarized using descriptive statistics and analyzed with GraphPad Prism and MedCalc software. RESULTS: This systematic review analyzed nine studies published between 2009 and 2024, encompassing 6031 patients with ALF, of whom 62.9% developed AKI. Most studies were retrospective and varied in methodology, setting, and population. Only three studies reported independent risk factors for the development of AKI among ALF patients, with significant variation in the risk factors studied. AKI in ALF patients significantly increased mortality, with hazard ratios ranging from 2.77 to 11.61. The review highlights the need for standardized diagnostic criteria and risk stratification to guide prevention and improve clinical outcomes in ALF. CONCLUSION: AKI is common in ALF, increasing morbidity and mortality; standardised diagnosis and targeted management strategies are urgently needed.