Ahmed A, Gautam M, Azim A, Chakravarti B, Tiwari M. Burden and impact of acute kidney injury in acute liver failure: A systematic review. World J Crit Care Med 2026; 15(1): 111114 [DOI: 10.5492/wjccm.v15.i1.111114]
Corresponding Author of This Article
Armin Ahmed, Critical Care Medicine, King George's Medical University, Shah Mina Road, Chowk, Lucknow 226003, Uttar Pradesh, India. drarminahmed@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Systematic Reviews
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Mar 9, 2026 (publication date) through Mar 6, 2026
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Publication Name
World Journal of Critical Care Medicine
ISSN
2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Ahmed A, Gautam M, Azim A, Chakravarti B, Tiwari M. Burden and impact of acute kidney injury in acute liver failure: A systematic review. World J Crit Care Med 2026; 15(1): 111114 [DOI: 10.5492/wjccm.v15.i1.111114]
Armin Ahmed, Department of Critical Care Medicine, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
Medhavi Gautam, Department of Medicine, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
Afzal Azim, Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Banadana Chakravarti, Meenakshi Tiwari, Centre for Advance Research, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
Co-corresponding authors: Armin Ahmed and Afzal Azim.
Author contributions: Ahmed A and Gautam M designed the research study; Ahmed A and Gautam M conducted the research; Azim A, Chakravarti B, and Tiwari M helped in drafting and correcting the manuscript; Ahmed A and Azim A have played important and indispensable roles in the manuscript preparation as the co-corresponding authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Armin Ahmed, Critical Care Medicine, King George's Medical University, Shah Mina Road, Chowk, Lucknow 226003, Uttar Pradesh, India. drarminahmed@gmail.com
Received: June 24, 2025 Revised: August 14, 2025 Accepted: November 14, 2025 Published online: March 9, 2026 Processing time: 249 Days and 23.5 Hours
Abstract
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.
Core Tip: This systematic review of nine studies (6031 patients) found that acute kidney injury (AKI) occurs in 62.9% of acute liver failure (ALF) cases, with incidence varying from 37.9% to 79.1%. Drug-induced ALF, especially paracetamol-related, was the predominant etiology in most cohorts, while viral hepatitis was more common in Asia. Few studies identified independent AKI risk factors, with systemic inflammation, shock, and tumor necrosis factor-alpha elevation among them. AKI was consistently associated with increased mortality and lower transplant-free survival. Significant gaps include a lack of etiological data, pathophysiological insights, and representation from low- and middle-income countries, highlighting the need for standardized definitions and multicenter research.
