Patients With Nonalcoholic Steatohepatitis and Renal Failure at Increased Risk for Mortality, Hospital Utilization

Investigators evaluated rates of mortality, hospital utilization, and hospital charges among patients with NASH with and without concurrent kidney failure.

Renal failure among patients with nonalcoholic steatohepatitis (NASH) was associated with increased hospital utilization and mortality risk. These findings, from a retrospective cohort study, were published in the Journal of Clinical Gastroenterology.

Patients (N=6855) with NASH included in the Healthcare Cost and Utilization Project database in 2016 were analyzed for this study. Inpatient mortality, hospital utilization, and clinical characteristics were assessed.

A total of 8.7% (n=598) of patients had kidney failure. The same number of patients who did not have kidney failure were propensity matched. Among the matched cohorts, kidney failure was associated with older age (P <.0001), more severe disease (P <.0001), longer hospital stay (P <.0001), and higher hospitalization charges (P <.0001).

In-hospital mortality occurred in 3.0% and 0.2% of patients with and without kidney failure, respectively (adjusted odds ratio [aOR], 28.72; 95% CI, 8.99-91.71; P <.0001).

Among the renal failure cohort, mortality was associated with hepatic encephalopathy (aOR, 26.38; 95% CI, 1.29-540.56; P <.033), Charlson Comorbidity Index >3 (aOR, 3.46; 95% CI, 1.04-11.51; P <.0432), and variceal bleeding (aOR, 3.02; 95% CI, 1.06-8.61; P <.039). Patients covered with Medicaid (aOR, 0.047; 95% CI, 0.28-0.79; P <.0039) and private insurance (aOR, 0.56; 95% CI, 0.38-0.83; P <.0038) were at lower risk for in-hospital mortality.

Average hospital stays were 6.4 and 3.1 days for patients with and without renal failure, respectively (b=3.02; 95% CI, 2.54-3.5; P <.0001). The mean hospital charge was $78,022.70 among patients with renal failure and $38,024.80 for patients without (b=$37,045.90; 95% CI, $31,756-$42,335; P <.0001).

This study was a retrospective analysis of administrative data, and as such is prone to errors and missing data.

These findings suggested that patients with NASH who also had renal failure were at increased risk for in-hospital mortality, longer length of stay, and increased hospital charges. Kidney health should be assessed, especially among patients with a high comorbidity index, such that renal failure may be prevented.


Reja M, Patel R, Pioppo L, et al. Renal failure is associated with increased mortality and hospital utilization in patients admitted with nonalcoholic steatohepatitis. J Clin Gastroenterol. 2021;55(5):433-438. doi: 10.1097/MCG.0000000000001389.