PREVALENCE AND FACTORS ASSOCIATED WITH HEPATORENAL SYNDROME AMONG PATIENTS ATTENDING MEDYLIFE HEALTHCARE HOSPITAL, GHANA

IRASS Journal of Multidisciplinary Studies https://irasspublisher.com/journal-details/IRASSJMS ISSN (Online) 3049-0073 This is an open access article under the CC BY-NC license 36 JOURNAL COVER PAGE PREVALENCE AND FACTORS ASSOCIATED WITH HEPATORENAL SYNDROME AMONG PATIENTS ATTENDING MEDYLIFE HEALTHCARE HOSPITAL, GHANA Aquel Rene Lopez1*, Priscilla Oforiwaa2, Akwesi Afriyie Achiampong3, Prince Adoba4, Robert Acquah5 1-2-3-4 Department of Medical Laboratory Science, School of Health and Allied Sciences, Baldwin University College, Accra 5 Department of Emergency Medicine, Sinel Specialist Hospital, Accra Corresponding Author: Aquel Rene Lopez Department of Medical Laboratory Science, School of Health and Allied Sciences, Baldwin University College, Accra Article History Received: 16 / 10 / 2025 Accepted: 12 / 12 / 2025 Published: 24 / 12 /2025 Abstract: Background: Hepatorenal syndrome (HRS) is a life-threatening complication of advanced liver disease, characterized by functional renal failure and poor prognosis. Evidence on its burden and associated factors in Ghana remains scarce. Methods: A hospital-based cross-sectional study was conducted between February and May 2025 among 80 adult patients with liver disease. Sociodemographic and clinical data were obtained using structured questionnaires. Venous blood samples were analyzed for liver and renal function parameters using a fully automated chemistry analyzer. Data were analyzed with SPSS version 26.0. Associations were evaluated using Spearman’s correlation and binary logistic regression, with statistical significance set at p < 0.05. Results: Liver disease was diagnosed in 68.8% of participants, among whom 58.2% had hepatorenal syndrome. The prevalence of HRS was higher in females (68.0%) than males (50.0%), though this difference was not statistically significant (p = 0.178). Renal dysfunction was widespread: 93.8% of participants had reduced estimated glomerular filtration rate, and 98.8% had elevated blood urea nitrogen levels. Alkaline phosphatase was elevated in all participants, while gamma-glutamyl transferase was elevated in 80%. Logistic regression showed increased odds of HRS among patients not on medication (OR = 3.49) and those with prior hospitalization (OR = 2.30), although these associations did not reach statistical significance. Conclusion: Hepatorenal syndrome is highly prevalent among liver-diseased patients at Medylife Healthcare Hospital, indicating a substantial burden of renal dysfunction. Early renal monitoring, medication adherence, and integrated multidisciplinary care are essential to reduce morbidity and improve outcomes in this population. Keywords: Hepatorenal syndrome ,Liver cirrhosis ,Acute kidney injury ,Renal dysfunction , Chronic liver disease; Ghana. How to Cite in APA format: Lopez, A. R., Oforiwaa, P., Achiampong, A. A., Adoba, P. & Acquah, R. (2025). PREVALENCE AND FACTORS ASSOCIATED WITH HEPATORENAL SYNDROME AMONG PATIENTS ATTENDING MEDYLIFE HEALTHCARE HOSPITAL, GHANA. IRASS Journal of Multidisciplinary Studies, 2(12),36-50. Introduction Liver cirrhosis is a significant health concern worldwide, often leading to severe complications and high mortality rates (Sepanlou et al., 2020). It is categorized into two primary stages: compensated and decompensated cirrhosis. In compensated cirrhosis, patients may remain asymptomatic for extended periods, whereas decompensated cirrhosis presents with critical symptoms such as ascites, variceal bleeding, and hepatic encephalopathy. The survival rates starkly differ between these stages, with patients experiencing approximately 12 years of survival in compensated cirrhosis compared to only 2 years in decompensated cases (Margarita et al., 2020). The transition from compensated to decompensated cirrhosis is primarily driven by portal hypertension, which significantly impacts patient outcomes (Badura et al., 2023). As liver disease progresses, patients may encounter further complications such as refractory ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome (HRS), among others (Chaney, 2021). HRS is particularly concerning due to its association with a poor prognosis. Early identification and understanding of HRS are crucial for timely intervention, which can include medical treatment or liver transplantation. Hepatorenal syndrome is characterized by a decline in kidney function occurring in the context of severe chronic liver diseases, such as advanced cirrhosis or acute liver failure (Sasso et al., 2021). The pathophysiology of HRS involves a complex interplay of factors that lead to renal impairment (Eknoyan & Epstein, 2021). It is primarily defined by a decrease in kidney perfusion resulting from a severe reduction in effective circulating volume, which triggers massive activation of the body's vasoactive systems (Rad et al., 2024). This process results in renal vasoconstriction occurring alongside systemic and splanchnic arterial vasodilation (Zaritsky et al., 2021). HRS is classified as an exclusion diagnosis; it is considered a functional pathology due to its potential reversibility following liver transplantation, although some debates persist regarding this classification (Jung & Chang, 2023). IRASS Journal of Multidisciplinary Studies Vol-2, Iss-12 (December-2025): 36-50 Vol-2, Iss-12 (December-2025) 37 Traditionally, two types of HRS have been recognized: Type 1 and Type 2. Type 1 HRS is marked by a rapid decline in renal function, with serum creatinine levels doubling to values exceeding 2.5 mg/dl within two weeks (Simonetto et al., 2020a). In contrast, Type 2 HRS presents a more gradual increase in serum creatinine levels above 1.5 mg/dl. The clinical manifestations of Type 1 are acute renal failure, while refractory ascites characterize Type 2 (Biggins et al., 2021). Diagnosing HRS necessitates ruling out other potential causes of kidney injury, including the lack of response to diuretic withdrawal or plasma volume expansion, absence of shock or nephrotoxic drug treatment, normal urine analysis findings, and normal renal ultrasound results (Biggins et al., 2021). Recent advancements have shifted the understanding of HRS significantly. Notably, the Hepatology Community and the International Club of Ascites have embraced new definitions for Acute Kidney Injury (AKI), recognizing systemic inflammation's role triggered by pathogen-associated molecular patterns in acute decompensation among cirrhotic patients (Laleman et al., 2018). While circulatory dysfunction remains a primary cause of HRS, emerging research has identified additional factors contributing to its development. These include systemic inflammation and conditions like cirrhotic cardiomyopathy (Chan et al., 2017). The pathophysiology underlying HRS also highlights the importance of systemic circulatory dysfunction and renal factors. Arteriolar splanchnic vasodilation plays a pivotal role in the development of this syndrome (Ginès et al., 2018b). Initially, mild portal hypertension occurs alongside decreased systemic vascular resistance due to organ vasodilation. This vasodilation results from the excessive production of vasodilators such as nitric oxide and carbon monoxide while their degradation diminishes due to increased portal pressure and portosystemic shunting (McConnell & Iwakiri, 2018). The body attempts to counteract these changes as a compensatory mechanism by increasing cardiac output and heart rate while activating potent vasoconstrictor systems like the sympathetic nervous system and the renin-angiotensin-aldosterone system (Borovac et al., 2020).These compensatory mechanisms can maintain normal blood pressure levels in compensated cirrhosis; however, once complications arise in decompensated cirrhosis, these systems often fail to function adequately (Gustot et al., 2021). This inadequacy leads to impaired renal blood flow and overall deterioration in organ function. Even at advanced stages of cirrhosis, reduced cardiac output compromises perfusion to vital organs (Engelmann et al., 2021). Consequently, these physiological changes contribute to sodium retention and fluid accumulation manifesting as ascites and edema further exacerbating kidney vasoconstriction and decreasing glomerular filtration rate (GFR), ultimately resulting in HRS development (Ginès et al., 2018a). If renal vasoconstriction persists unaddressed, it may lead to damage within the kidney parenchyma followed by acute tubular necrosis (Rasmussen et al., 2024). Concisely, hepatorenal syndrome represents a critical complication arising from an advanced liver disease characterized by complex interactions between circulatory dysfunction and renal impairment. Understanding these mechanisms is essential for early detection and management strategies aimed at improving patient outcomes in those suffering from liver cirrhosis. Material and Methods Study Design This study employed a hospital-based cross-sectional design to determine the prevalence of hepatorenal syndrome (HRS) and to assess associated demographic and clinical factors among patients with liver disease. The cross-sectional approach was considered appropriate because it allows for the simultaneous assessment of exposure variables and outcomes within a defined population at a single point in time, making it suitable for estimating disease prevalence and identifying potential associations. This design enabled the evaluation of renal and hepatic biochemical parameters alongside sociodemographic and clinical characteristics, providing a snapshot of the burden of hepatorenal syndrome within the study population. While causal relationships cannot be inferred due to the observational nature of the design, the study offers valuable insight into the magnitude of HRS and its correlates in a real-world clinical setting.. Study Site The study was conducted at Medylife Healthcare Hospital, a private health facility located in Accra, Ghana. The hospital serves as both a primary healthcare provider and a referral center for residents within Caprice and surrounding communities, including Nima, Maamobi, Accra New Town, Circle, Pig Farm, and neighboring areas. Its strategic location allows it to serve a diverse patient population with varied demographic and socioeconomic backgrounds. Medylife Healthcare Hospital is accredited by the National Health Insurance Authority and operates a 24-hour service delivery system. The facility offers a wide range of clinical services, including general outpatient care, internal medicine, surgical services, medical imaging, cardiology diagnostics, gastroenterology services, renal unit care, neurological diagnostics, ophthalmic services, and comprehensive laboratory investigations. The presence of both gastroenterology and renal care services makes the hospital particularly suitable for studies involving liver disease and its complications, including hepatorenal syndrome. The hospital’s laboratory is equipped with fully automated chemistry analyzers and operates according to standard operating procedures that support reliable biochemical assessment of liver and kidney function. These diagnostic capabilities, coupled with consistent patient flow and specialist consultations, provided an appropriate clinical environment for the assessment of hepatorenal syndrome prevalence and associated factors. Study Population The study population comprised adult patients diagnosed with liver disease who attended Medylife Healthcare Hospital in Accra, Ghana, during the study period from February to May 2025. Eligible participants included both inpatients and outpatients receiving evaluation, treatment, or follow-up care for liver-related conditions. The study population reflected a heterogeneous group with varying demographic characteristics, clinical presentations, and etiologies of liver disease, providing a representative snapshot IRASS Journal of Multidisciplinary Studies Vol-2, Iss-12 (December-2025): 36-50 Vol-2, Iss-12 (December-2025) 38 of patients at risk of developing hepatorenal syndrome within the hospital setting. Participants were recruited consecutively to minimize selection bias and ensure that all eligible patients presenting during the study period had an equal opportunity of inclusion. Only patients aged 18 years and older who provided informed consent were enrolled. Patients with liver disease complicated by acute kidney injury or chronic kidney impairment were included, provided the renal dysfunction was attributable to liver disease. Patients with intrinsic renal disease unrelated to liver pathology, those receiving renal replacement therapy, pregnant women, and lactating mothers were excluded to reduce confounding and ensure accurate assessment of hepatorenal syndrome. This approach ensured that renal dysfunction observed in the study population was most likely related to hepatic pathology and associated circulatory disturbances. Inclusion criteria Participants were eligible for inclusion in this study if they met all of the following criteria:  Adults aged 18 years and older  Patients diagnosed with liver disease (including viral, alcoholic, or metabolic etiologies) attending Medylife Healthcare Hospital  Patients with liver disease complicated by renal impairment, including acute kidney injury or reduced renal function attributable to liver pathology  Both inpatients and outpatients receiving evaluation, treatment, or follow-up care during the study period  Patients who provided written informed consent to participate in the study These criteria ensured the inclusion of individuals at risk of developing hepatorenal syndrome, thereby enabling accurate assessment of its prevalence and associated factors within the study population. Exclusion criteria Participants were excluded from the study if they met any of the following criteria:  Pregnant women and lactating mothers, due to physiological alterations in renal and hepatic function  Patients with intrinsic renal disease unrelated to liver pathology, including chronic kidney disease of nonhepatic origin  Patients who had undergone renal replacement therapy, including hemodialysis or peritoneal dialysis  Patients with acute kidney injury secondary to causes other than liver disease, such as sepsis-related acute tubular necrosis or drug-induced nephrotoxicity  Patients who were unable or unwilling to provide informed consent These exclusion criteria were applied to minimize confounding factors and ensure that renal dysfunction observed in the study was most likely attributable to hepatic disease and its associated circulatory disturbances Ethical Consideration Endorsement for this ongoing review was obtained from the Ethical Review Committee of the School of Allied Health Sciences, Baldwin University College, Ministry of Health, and Medylife Healthcare Hospital. Participants were also informed about the study goals and aims and were assured about the confidentiality of the information they would be providing for this study. Statistical Analysis Data were cleaned and coded in Microsoft Excel and analyzed using SPSS version 26.0. Descriptive statistics summarized demographic, clinical, and biochemical variables as frequencies and percentages for categorical data and means with standard deviations for continuous data. Normality was assessed prior to inferential analysis. Associations were examined using appropriate correlation tests, including Spearman’s rank correlation for non-normally distributed variables and Pearson’s correlation for normally distributed data. Binary logistic regression was used to identify factors associated with hepatorenal syndrome, with results reported as odds ratios and 95% confidence intervals. All analyses were two-tailed, and statistical significance was set at p < 0.05 Results Table 1 General Descriptive Statistics of the Study Population Table 1 below summarizes the sociodemographic characteristics and biochemical profiles of the study participants. A total of 80 patients were included in the analysis, comprising 48 males (60.0%) and 32 females (40.0%). The overall mean age of the participants was 50.44 ± 13.44 years. Males had a mean age of 48.56 ± 13.18 years, while females were slightly older with a mean age of 53.25 ± 13.54 years; however, this difference was not statistically significant (p = 0.127). Similar age distributions have been reported among patients with chronic liver disease in other hospital-based studies, suggesting that age alone may not be a primary determinant of disease severity or renal complications in cirrhosis (Ginès et al., 2018; Margarita et al., 2020). The majority of participants identified as Christians (65.0%), followed by Muslims (21.3%) and individuals practicing traditional religions (13.8%). Religious affiliation did not differ significantly by sex (p = 0.294). Nearly half of the participants were married (47.5%), while 25.0% were single, 12.5% divorced, and 11.3% widowed. Marital status showed no statistically significant association with sex (p = 0.267), consistent with previous findings that sociodemographic variables such as marital status have limited influence on the biological progression of liver disease and its complications (Testino & Ferro, 2010). Biochemical assessment revealed widespread renal dysfunction among the study population. Serum creatinine levels differed significantly by sex (p = 0.006), with a higher proportion of females exhibiting abnormal values. This finding aligns with evidence that serum creatinine may underestimate renal impairment in patients with cirrhosis, particularly among females, due to reduced muscle mass and altered creatinine metabolism (Mindikoglu & Pappas, 2018; Wong et al., 2025). Elevated blood urea nitrogen was observed in 98.8% of participants, while reduced estimated glomerular filtration rate was present in 93.8%, IRASS Journal of Multidisciplinary Studies Vol-2, Iss-12 (December-2025): 36-50 Vol-2, Iss-12 (December-2025) 39 highlighting severe impairment of renal perfusion, a hallmark of hepatorenal syndrome (Simonetto et al., 2020). Liver function tests demonstrated marked abnormalities. Alkaline phosphatase levels were elevated in all participants (100%), and gamma-glutamyl transferase was elevated in 80.0%, indicating significant hepatobiliary dysfunction. Elevated aspartate aminotransferase was observed in 56.3% of participants, whereas alanine aminotransferase elevation was less frequent (6.3%). Total bilirubin levels remained within normal limits for all participants, suggesting compensated or subclinical hepatic dysfunction despite significant biochemical derangements, a pattern previously described in patients at risk of hepatorenal syndrome (Ginès et al., 2018; Velez et al., 2020). Table 1 General Descriptive Statistics of the Study Population Variable Male (N=48) Female (N=32) Total (N=80) P-value Age (years) 48.56±13.18 53.25±13.54 50.44±13.44 0.127 Religion 0.294 Christian 29(60.4) 23 (71.9) 52(65.0) Muslim 13(27.1) 4 (12.5) 17(21.3) Traditional 6 (12.5) 5 (15.6) 11(13.8) Marital Status 0.267 Single 13(27.1) 7 (21.9) 20(25.0) Cohabiting 0 (0.00) 3 (9.40) 3 (3.80) Married 23(47.9) 15 (46.9) 38(47.5) Divorced 7 (14.6) 3 (9.40) 10(12.5) Widowed 5 (10.4) 4 (12.5) 9 (11.3) Creatinine Levels 0.006 Low 0 (0.00) 2 (6.30) 2 (2.50) Normal 47(97.9) 24 (75.0) 71(88.8) High 1 (2.10) 6 (18.8) 7 (8.80) BUN Levels 0.411 Normal 1 (2.10) 0 (0.00) 1 (1.30) High 47(97.9) 32 (100) 79(98.8) eGFR levels 1.000 Low 45(93.8) 30 (93.8) 75(93.8) Normal 3 (6.30) 2 (6.30) 5 (6.30) ALT Levels 1.000 Normal 45(93.8) 30 (93.8) 75(93.8) High 3 (6.30) 2 (6.30) 5 (6.30) AST Levels 0.645 Normal 22(45.8) 13 (40.6) 35(43.8) High 26(54.2) 19 (59.4) 45(56.3) ALP Levels - Normal 0 (0.00) 0 (0.00) 0 (0.00) High 48(100) 32 (100) 80(100) GGT Levels 0.424 Normal 11(22.9) 5 (15.6) 16(20.0) High 37(77.1) 27 (84.4) 64(80.0) Total Bilirubin - Normal 48(100) 32 (100) 80(100) High 0 (0.00) 0 (0.00) 0 (0.00) IRASS Journal of Multidisciplinary Studies Vol-2, Iss-12 (December-2025): 36-50 Vol-2, Iss-12 (December-2025) 40 Figure 1: Prevalence of Liver Disease among the Study Population Figure 1 illustrates the prevalence of liver disease among the study participants, stratified by sex. Overall, 68.8% (55/80) of the participants were diagnosed with liver disease, while 31.2% (25/80) had no evidence of liver disease. Among males, 62.5% were diagnosed with liver disease compared with 78.1% of females, indicating a higher observed prevalence among female participants. Although females exhibited a greater burden of liver disease than males, this difference was not statistically significant, suggesting that sex alone may not be a decisive determinant of liver disease occurrence in this population. Similar patterns have been reported in hospital-based studies in sub-Saharan Africa, where delayed presentation, metabolic risk factors, and viral hepatitis contribute substantially to liver disease prevalence across both sexes (Sepanlou et al., 2020; Nartey et al., 2022). The high overall prevalence observed in this study reflects the significant burden of chronic liver disease among patients attending tertiary and referral healthcare facilities. This finding is consistent with global evidence indicating that liver disease is increasingly prevalent in lowand middle-income countries, driven by chronic viral hepatitis, alcohol-related liver disease, and emerging non-alcoholic fatty liver disease (Ginès et al., 2018). The substantial proportion of affected individuals in this cohort underscores the importance of early detection and continuous monitoring of liver disease to prevent progression to severe complications, including hepatorenal syndrome. Figure .2: Prevalence of Hepatorenal Syndrome among Liver-Diseased Participants Figure 2 presents the prevalence of hepatorenal syndrome (HRS) among participants diagnosed with liver disease, disaggregated by sex. Of the patients with liver disease, 58.2% (32/55) were diagnosed with hepatorenal syndrome, while 41.8% (23/55) had no evidence of HRS, demonstrating a substantial burden of renal complications in this clinical subgroup. Sex-specific analysis showed that 50.0% of male patients with liver disease developed HRS, compared with 68.0% of female patients. Although the prevalence of HRS was notably higher among females, the difference did not reach statistical significance, suggesting that sex alone may not independently predict HRS occurrence in this cohort. Similar observations have been reported in studies indicating that while sex-based 62.50% 78.10% 68.80% 37.50% 21.90% 31.20% Male Female Total Prevalence of Liver Disease Yes No 50.00% 68.00% 58.20% 50.00% 32.00% 41.80% Male Female Total Prevalence of Hepatorenal Syndrome Yes No IRASS Journal of Multidisciplinary Studies Vol-2, Iss-12 (December-2025): 36-50 Vol-2, Iss-12 (December-2025) 41 physiological and hormonal differences may influence disease progression, HRS primarily reflects advanced circulatory and inflammatory derangements rather than demographic characteristics (Ginès et al., 2018; Simonetto et al., 2020). The high prevalence of HRS observed in this study exceeds figures reported in many high-income settings but is comparable to findings from resource-limited environments, where late presentation of liver disease and limited access to specialized interventions contribute to worse renal outcomes (Sabry et al., 2024). This finding underscores the severity of liver disease at presentation in the study population and highlights the urgent need for early renal assessment and timely therapeutic intervention to reduce morbidity and mortality associated with hepatorenal syndrome. Table 2 Demographic Factors Associated with Hepatorenal Syndrome Table 2 presents the association between selected demographic variables and the occurrence of hepatorenal syndrome (HRS) among patients with liver disease. Of the 55 participants with liver disease included in this analysis, 32 (58.2%) were diagnosed with HRS, while 23 (41.8%) had no evidence of HRS. Females accounted for a slightly higher proportion of HRS cases (53.1%) compared with males (46.9%). Conversely, males constituted a greater proportion of the non-HRS group (65.2%). Although this pattern suggests a possible higher susceptibility to HRS among females, the association between sex and HRS was not statistically significant (p = 0.178). This finding aligns with previous studies indicating that while sex-related physiological and hormonal differences may influence disease expression, HRS development is largely driven by advanced circulatory dysfunction rather than demographic characteristics alone (Ginès et al., 2018; Simonetto et al., 2020). Religious affiliation showed no significant association with HRS occurrence (p = 0.835). Christians constituted the majority of both HRS (68.8%) and non-HRS (65.2%) groups, reflecting the general religious distribution of the study population. This observation is consistent with existing literature, which does not identify religion as an independent determinant of hepatorenal syndrome (Testino & Ferro, 2010). Similarly, marital status was not significantly associated with the development of HRS (p = 0.771). Married participants represented the largest proportion in both the HRS (46.9%) and non-HRS (47.8%) groups, followed by single, divorced, and widowed individuals. These findings suggest that sociodemographic factors such as marital status do not directly influence the pathophysiological progression from liver disease to hepatorenal syndrome, a conclusion supported by prior hospitalbased studies (Akbas et al., 2025). Overall, the results indicate that demographic characteristics alone were not significant predictors of hepatorenal syndrome in this cohort, reinforcing the concept that HRS is predominantly a consequence of advanced hepatic and circulatory derangements rather than sociodemographic determinants. Table 2 Demographic Factors Associated with Hepatorenal Syndrome Variable Diagnosed with HRS (N=32) Have no HRS (N=23) Total (N=55) P-value Gender 0.178 Male 15 (46.9) 15 (65.2) 30 (54.5) Female 17 (53.1) 8 (34.8) 25 (45.5) Religion 0.835 Christian 22 (68.8) 15 (65.2) 37 (67.3) Muslim 5 (15.6) 5 (21.7) 10 (18.2) Traditional 5 (15.6) 3 (13.0) 8 (14.5) Marital Status 0.771 Single 10 (31.3) 5 (21.7) 15 (27.3) Married 15 (46.9) 11 (47.8) 26 (47.3) Divorced 4 (12.5) 3 (13.0) 7 (12.7) Widowed 3 (9.4) 4 (17.4) 7 (12.7) Table 3 Clinical Factors Associated with Hepatorenal Syndrome Table 3 summarizes the clinical characteristics associated with hepatorenal syndrome (HRS) among patients with liver disease. A total of 55 participants were included in this analysis, of whom 32 (58.2%) were diagnosed with HRS and 23 (41.8%) had no evidence of the syndrome. Regarding the etiology of liver disease, hepatitis C virus infection was the most frequently observed condition in both groups, affecting 25.0% of patients with HRS and 43.5% of those without HRS. Hepatitis B virus was also common, while alcoholic liver disease and non-alcoholic fatty liver disease (NAFLD) were more prevalent among patients with HRS. Despite these observed differences, the type of liver disease was not significantly associated with HRS development (p = 0.222). Similar findings have been reported in previous studies, suggesting that while etiology contributes to disease progression, it does not independently predict HRS onset (Ginès et al., 2018; Akbas et al., 2025). The duration of liver disease showed no significant association with HRS. Patients with disease duration exceeding five years constituted 62.5% of the HRS group and 60.9% of the IRASS Journal of Multidisciplinary Studies Vol-2, Iss-12 (December-2025): 36-50 Vol-2, Iss-12 (December-2025) 42 non-HRS group (p = 0.902), indicating that chronicity alone may not be a decisive factor in the development of HRS. This supports evidence that acute decompensating events, rather than disease duration, play a critical role in precipitating renal dysfunction in cirrhosis (Liu et al., 2021). A higher proportion of patients with HRS had a history of hospitalization in previous years (78.1%) compared with those without HRS (60.9%); however, this difference was not statistically significant (p = 0.165). Medication use demonstrated a notable trend: 65.6% of HRS patients were on medication compared with 87.0% of non-HRS patients, suggesting a potential protective effect of treatment adherence, although this association did not reach statistical significance (p = 0.073). Previous studies have highlighted the importance of early pharmacological intervention in reducing the risk of HRS (Biggins et al., 2021). Renal function markers were markedly abnormal across both groups. Low estimated glomerular filtration rate was present in over 90% of participants in both groups, and blood urea nitrogen levels were elevated in nearly all patients, with no significant differences observed. Serum creatinine levels were predominantly within normal ranges, reflecting the known limitations of creatinine-based renal assessment in cirrhotic patients (Mindikoglu & Pappas, 2018; Wong et al., 2025). Liver enzyme abnormalities, including elevated alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase, were common but did not differ significantly between groups. Additionally, the presence of comorbid conditions such as hypertension or diabetes showed no association with HRS occurrence (p = 0.984). These findings reinforce the concept that hepatorenal syndrome is primarily driven by systemic circulatory and hemodynamic disturbances rather than isolated biochemical or comorbid factors (Simonetto et al., 2020). Table 3 Clinical Factors Associated with Hepatorenal Syndrome Variable Diagnosed with HRS (N=32) Have no HRS (N=23) Total (N=55) P-value Type of Liver Disease 0.222 HBV 7 (21.9) 7 (30.4) 14 (25.5) HCV 8 (44.4) 10 (43.5) 18 (32.7) Alcoholic Liver 9 (28.1) 4 (17.4) 13 (23.6) NAFLD 8 (25.0) 2 (8.70) 10 (18.2) Duration of liver disease 0.902 ≤5 years 12 (37.5) 9 (39.1) 21 (38.2) >5 years 20 (62.5) 14 (60.9) 34 (61.8) Hospitalized in past years 0.165 Yes 25 (78.1) 14 (60.9) 39 (70.9) No 7 (21.9) 9 (39.1) 16 (29.1) On medication 0.073 Yes 21 (65.6) 20 (87.0) 41 (74.5) No 11 (34.4) 3 (13.0) 14 (25.5) eGFR Levels 0.730 Low 30 (93.8) 21 (91.3) 51 (92.7) Normal 2 (6.30) 2 (8.70) 4 (7.30) BUN Levels 0.392 Normal 1 (3.10) 0 (0.00) 1 (1.80) High 31 (96.9) 23 (100) 54 (98.2) Creatinine levels 0.616 Low 1 (3.10) 0 (0.00) 1 (1.80) Normal 27 (84.4) 21 (91.3) 48 (87.3) High 4 (12.5) 2 (8.70) 6 (10.90) ALT Levels 0.479 Normal 29 (90.6) 22 (95.7) 51 (92.7) High 3 (9.40) 1 (4.30) 4 (7.30) AST Levels 0.396 Normal 13 (40.6) 12 (52.2) 25 (45.5) High 19 (59.4) 11 (47.8) 30 (54.5) IRASS Journal of Multidisciplinary Studies Vol-2, Iss-12 (December-2025): 36-50 Vol-2, Iss-12 (December-2025) 43 GGT Levels 0.402 Normal 7 (21.9) 3 (13.0) 10 (18.2) High 25 (78.1) 20 (87.0) 45 (81.8) Comorbidity 0.984 Yes 14 (43.8) 10 (43.5) 24 (43.6) No 18 (56.3) 13 (56.5) 31 (56.4) Table 4 Determinants of Hepatorenal Syndrome Table 4 presents the results of a binary logistic regression analysis identifying potential determinants of Hepatorenal Syndrome (HRS) among liver-diseased patients at Medylife Healthcare Hospital. The table displays the odds ratios (OR), 95% confidence intervals (CI), and p-values for various sociodemographic and clinical variables, offering insight into which factors may influence the likelihood of developing HRS. Beginning with gender, female participants were found to be 2.13 times more likely to develop HRS compared to their male counterparts, who served as the reference group. However, the confidence interval (0.71–6.41) crosses one, and the p-value of 0.181 indicates that this association was not statistically significant, though it points to a possible trend of increased susceptibility among women. Looking at religious affiliation, Christians were used as the baseline. Muslims had a reduced likelihood of developing HRS with an OR of 0.68 (95% CI: 0.17–2.77), though this was not significant (p = 0.593). Interestingly, participants practicing Traditional religion were 1.14 times more likely to have HRS (95% CI: 0.24–5.49), and although the p-value is stated as 0.025, the wide confidence interval and small sample size suggest this may be a statistical anomaly or reporting error, and the result should be interpreted with caution. In terms of marital status, single participants were 2.67 times more likely to develop HRS (95% CI: 0.42–16.83), and those married had an OR of 1.82 (95% CI: 0.34–9.83). Divorced individuals had an OR of 1.78 (95% CI: 0.21–14.77), while widowed participants served as the reference group. None of these associations were statistically significant (p > 0.05 for all), but the elevated odds among single individuals hint at potential social or care-related disparities. Concerning the type of liver disease, patients with alcoholic liver disease had more than double the odds (OR = 2.25) of developing HRS compared to those with hepatitis B (reference group), though this was not significant (95% CI: 0.47–10.88; p = 0.313). Those with non-alcoholic fatty liver disease (NAFLD) had a notably higher odds ratio of 4.00, suggesting a fourfold increased risk of HRS compared to HBV patients, but this association was not statistically significant (95% CI: 0.62–25.96; p = 0.146). Patients with hepatitis C virus (HCV) infection were slightly less likely to develop HRS (OR = 0.80; p = 0.755). Considering the duration of liver disease, those who had been ill for more than five years had only a marginally increased odds (OR = 1.07) of developing HRS compared to those with five years or less. This association was negligible and not statistically significant (p = 0.902), suggesting that disease duration alone does not strongly predict HRS occurrence. Among patients previously hospitalized, the odds of developing HRS were 2.30 times higher than for those who had not been hospitalized (95% CI: 0.70–7.51; p = 0.169), suggesting a possible trend toward increased risk among patients with prior admissions, likely due to more advanced disease or complications. Medication use appeared to play a potentially important role. Patients not on medication were found to be 3.49 times more likely to develop HRS compared to those on treatment, with a pvalue of 0.083. While this result does not meet the standard level of statistical significance, it suggests a meaningful clinical trend that adherence to prescribed therapy may be protective against renal complications. As for renal function, patients with low eGFR had 1.43 times the odds of developing HRS compared to those with normal eGFR, though this result was not statistically significant (p = 0.732) and had an unusual confidence interval (possibly misreported with a lower bound of –0.19). Regarding liver enzyme markers, those with elevated ALT were more than twice as likely to develop HRS (OR = 2.28; 95% CI: 0.22–23.39), while those with elevated AST had 1.59 times greater odds. However, both indicators had wide confidence intervals and non-significant p-values (0.489 and 0.397, respectively), meaning no firm conclusion could be drawn. Finally, the presence of comorbidities such as hypertension or diabetes showed no effect on HRS risk. Participants with comorbid conditions had an odds ratio of 1.01 (95% CI: 0.34–2.98; p = 0.984), identical to those without, suggesting no association at all between comorbidity status and the development of HRS in this cohort. IRASS Journal of Multidisciplinary Studies Vol-2, Iss-12 (December-2025): 36-50 Vol-2, Iss-12 (December-2025) 44 Table 4 Determinants of Hepatorenal Syndrome Variables OR (95% CI) P-value Gender Male 1 Female 2.13(0.71-6.41) 0.181 Religion Christian 1 Muslim 0.68 (0.17-2.77) 0.593 Traditional 1.14(0.24-5.49) 0.025 Marital Status Single 2.67(0.42-16.83) 0.297 Married 1.82(0.34-9.83) 0.487 Divorced 1.78(0.21-14.77) Widowed 1 Type of Liver Disease HBV 1 HCV 0.80(0.20-3.25) 0.755 Alcoholic Liver 2.25(0.47-10.88) 0.313 NAFLD 4.00(0.62-25.96) 0.146 Duration of liver disease ≤5 years 1 >5 years 1.07 (0.36-3.22) 0.902 Hospitalized in past years Yes 2.30(0.70-7.51) 0.169 No 1 On medication Yes 1 No 3.49(0.85-14.39) 0.083 eGFR Levels Low 1.43(-0.19-10.96) 0.732 Normal 1 ALT Levels Normal 1 High 2.28(0.22-23.39) 0.489 AST Levels Normal 1 High 1.59(0.54-4.70) 0.397 Comorbidity Yes 1.01(0.34-2.98) 0.984 No 1 Discussion Hepatorenal Syndrome (HRS) remains a critical complication of advanced liver disease, particularly in patients with cirrhosis and ascites. Recent clinical studies consistently highlight HRS as one of the most severe forms of acute kidney injury in cirrhotic patients, often associated with high morbidity and mortality. Global evidence confirms that HRS frequently develops in the context of advanced liver dysfunction and circulatory changes, emphasizing its significance as a major clinical concern in both hospital and specialized liver care settings. This study sought to determine the prevalence and identify the factors associated with Hepatorenal Syndrome (HRS) among patients attending Medylife Healthcare Hospital. In line with its specific objectives, the discussion interprets findings on the general characteristics of the study population, the prevalence of liver disease and HRS, and the demographic and