The global prevalence of chronic kidney disease (CKD) is increasing, leading to higher mortality among affected individuals and placing a growing burden on health care systems. A large international study co-led by UHN examined the prevalence and impact of CKD in those with cirrhosis—permanent scarring and damage of the liver. The researchers found that CKD negatively impacts the prognosis of patients with cirrhosis in a global cohort.

CKD occurs when the kidneys are damaged or do not function as they should for a prolonged period of time. It was once thought to be uncommon in patients with cirrhosis. However, its prevalence has increased among those with advanced liver disease. Experts say this increase is being driven by growing rates of other co-occurring metabolic conditions such as obesity, diabetes, and high blood pressure, as well as broader diagnostic criteria that identify CKD earlier.

However, most evidence on CKD in cirrhosis comes from Western countries, with minimal reporting from Africa, South America, or Oceania. To assess the global prevalence of CKD in cirrhosis and its impact on patient outcomes, the research team analyzed data from more than 7,000 hospitalized patients with cirrhosis enrolled in the Chronic Liver Disease Evolution and Registry for Events and Decompensation (CLEARED) consortium.

The study found that approximately 18% of people hospitalized with cirrhosis also had CKD. Rates were highest in high-income countries, where metabolic syndrome—a cluster of conditions that includes obesity, diabetes, high blood pressure, high cholesterol and fatty liver disease—is more common.

In patients with cirrhosis, CKD was more likely seen in those with ascites, a liver complication caused by a build-up of fluid in the abdomen. Patients with both CKD and cirrhosis also had more complex liver complications. Acute kidney injury (AKI), a sudden decline in kidney function, was the most common complication during hospitalization. It affected nearly 60% of patients with CKD, more than double the rate seen in patients without CKD. Patients in the hospital with both CKD and cirrhosis also had a higher risk of death during or shortly after hospitalization.

The results show that CKD negatively impacts outcomes for patients with cirrhosis, highlighting the need for closer monitoring and treatment of kidney disease in these patients. Careful management of ascites and lifestyle changes aimed at reducing risk factors could help improve outcomes, particularly in high-income countries.

Dr. Florence Wong is an Affiliate Scientist at UHN’s Organ Systems and Integrated Health Sciences Research Institute and a Professor in the Department of Medicine at The University of Toronto. She is the lead and corresponding author of the study.

This research was supported by UHN Foundation.

Wong F, Adebayo D, George J, Idilman R, Hayes PC, Alvares-da-Silva MR, Torre A, Mekonnen HD, Seto WK, Sarin SK, Cao Z, Rajoriya N, Nagral A, Fisseha H, Kulkarni AV, Zhu C, Debzi N, Farias AQ, Su M, Goel A, Marciano S, Livingstone R, Dhiman RK, Gao Y, Malé-Velázquez R, Demitars CO, Bera C, Jiang YF, Velarde-Ruiz Velasco JA, Tan HK, Zhao C, Huezo MSG, Asrani SK, Wang L, Lu M, Michalczuk MT, Barutcu S, Cordova-Gallardo J, Gofton C, Gounder M, Shaw J, Albhaisi S, Zheng X, Aravinthan A, Rajaram RB, Jothimani D, Thanapirom K, Benitez C, Dincer D, Saraya A, Xu B, Lin M, Wu X, Liu C, Reddy R, Bush B, Thacker LR, Topazian M, Xie Q, Silvey S, Kamath PS, Choudhury A, Bajaj JS; CLEARED Investigators. Chronic kidney disease in cirrhosis: a study of inpatients from a global perspective. Gut. 2026 Jun 5. doi: 10.1136/gutjnl-2025-336802. Epub ahead of print.