For your patients with cirrhosis and ascites, the kidneys can’t wait. The American Association for the Study of Liver Diseases (AASLD) has updated their Guidance with a key recommendation: elimination of an absolute serum creatinine (SCr) threshold for diagnosis of hepatorenal syndrome acute kidney injury (HRS-AKI / HRS-1). This Guidance, which aligns with a 2015 recommendation from the International Club of Ascites (ICA), may lead to earlier diagnosis and improved treatment outcomes.1-3

The 2021 AASLD Guidance recommendations for assessment are:

Increase in SCr ≥0.3 mg/dL within 48 hours1
Percent increase in SCr that is ≥50% of what was known or presumed to have occurred within the prior 7 days1


  1. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74:1014-1048.
  2. Angeli P, Ginès P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut. 2015;64:531-537.
  3. Wong F, Pappas SC, Vargas HE, Frederick RT, Sanyal A, Jamil K. The diagnosis of hepatorenal syndrome (HRS): how much does use of the 2015 revised consensus recommendations affect earlier treatment and serum creatinine (SCr) at treatment start? Poster presented at: International Liver Congress™ of the European Association for the Study of the Liver; April 10-14, 2019; Vienna, Austria. Poster SAT-141.

ClinTopics Roundtable

Expert Review of the Updated Guidance on the Diagnosis and Volume Management in Hepatorenal Syndrome Type 1 (HRS-1)

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