Cullaro G, et al. - Given that acute kidney injury (AKI) is a critical determinant of outcomes in hospitalized patients with cirrhosis, experts studied the effect of AKI in the outpatient setting by analyzing data of 385 adult outpatients with cirrhosis listed for liver transplant at a single center, excluding those with severe hepatic encephalopathy, hepatocellular carcinoma or hemodialysis. A multivariable Cox regression analysis showed that baseline serum creatinine (bCr) and ΔCr were the only factors independently linked to the development of persistent kidney injury. AKI is not only common in outpatients with cirrhosis but even "clinically normal" bCr levels have a significant impact on the risk of persistent kidney injury and waitlist mortality due to the need for a lower clinical threshold to initiate renal function monitoring and the implementation of kidney-protective strategies.