Country-Level Socioeconomic Status, Healthcare Impact AKI Outcomes in Cirrhosis

Patients with acute kidney injury (AKI) and cirrhosis who are from low-income countries without effective universal health coverage face worse outcomes and have a higher risk of mortality, according to findings from a recent study.

The research was presented at The Liver Meeting 2024 from the American Association for the Study of Liver Diseases (AASLD) in San Diego, California, by Kavish Patidar, DO, an assistant professor of medicine at Baylor College of Medicine and a gastroenterologist and transplant hepatologist at Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center.

“Because [AKI] is the costliest complication of cirrhosis, we wanted to look into whether or not the country level income level and how well you deliver healthcare impacts outcomes,” Patidar explained to HCPLive.

He and a team of researchers enrolled hospitalized patients with cirrhosis from 67 centers in 5 continents, including Africa, Asia, Europe, North America, and South America, between July 2022 and May 2023. Socioeconomic status was categorized by World Health Organization Universal Health Coverage Index (UHC) and World Bank Gross National Income (GNI), with UHC >80 defined as effective universal health coverage and GNI ≥ $13,845 defined as a high-income country. The study’s primary outcomes were 28-day mortality and AKI non-resolution.

In total, the study included 3792 patients, 1456 (36%) of whom developed AKI. A total of 573 (39%) patients were from countries with UHC <80, while 657 (45%) patients were from countries with middle/low income (GNI < $13,845).

Upon analysis, patients from countries with UHC <80 and middle/low income had a higher cumulative incidence of 28-day mortality and lower rates of liver transplant (0.8% vs 8.0%; P <.001). Investigators noted GNI and UHC were highly colinear and analyzed their association with 28-day mortality in 2 separate multivariable competing risk models using liver transplant as the competing risk. In both models, UHC <80 and GNI <$13845 were associated with a greater risk of 28-day mortality (sHR, 1.73; P <.001 and sHR, 2.18; P <.001, respectively).

However, no associations were found between UHC, GNI, and AKI non-resolution on multivariable analysis.

“What we found was expected,” Patidar explained. “We knew that access to health care is important, and if AKI is the costliest complication [of cirrhosis], then you know that having less access to healthcare is going to impact outcomes."

He went on to say the results “open our eyes” and “tell us we need to do more work,” specifically pointing to the need for programs that expand access to healthcare and additional research on whether or not these programs are helping to fix the issue at hand.

Editors’ note: Patidar is an advisory board member for Madrigal Pharmaceuticals. The present study was sponsored by the International Club of Ascites.

Reference

^{Patidar K, Ma A, Juanola A, et al. 4127 - Global Socioeconomic Disparities Affect Acute Kidney Injury Outcomes in Hospitalized Patients with Cirrhosis: An Analysis of the International Club of Ascites GLOBAL AKI Study. Paper presented at: AASLD’s The Liver Meeting 2024. San Diego, California. November 15-19, 2024.}