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Introduction Acute kidney injury (AKI) in patients with cirrhosis carries high mortality, and management remains complex. Implementation of current guidelines is paramount to improving outcomes, particularly following the Medicine and Healthcare products Regulatory Agency (MHRA) 2023 safety update on terlipressin. This study aimed to evaluate the current management of patients with AKI and chronic liver disease (CLD) at a teaching hospital and the knowledge of clinicians in relation to up-to-date guidelines.Methods Data was collected between January and July 2025. Patients were included who had known CLD and admitted with any stage of AKI. Data collected included demographics, AKI stage, terlipressin and albumin use, and mortality. Results were compared against the MHRA guidance. A survey assessing knowledge across key domains (AKI physiology, international club of ascites (ICA) diagnostic criteria for hepatorenal syndrome (HRS), early AKI management in cirrhosis, and MHRA terlipressin safety guidance) was administered to clinicians.Results 35 patients were screened, and 21 inpatients met our inclusion criteria (mean age of 63 +/- 12 years; 67% male). Most common diagnosis was alcohol-related liver disease with a median MELD-Na of 28 (range 19–42). Inpatient mortality was 66% and average length of stay was 26 days. HRS was the most documented AKI aetiology (n= 7) followed by pre-renal (n= 6). Nine patients (43%) met ≥1 MHRA-defined high-risk criterion; six received terlipressin for suspected HRS and mortality in this group was 100%. Albumin was administered correctly according to current guidance in 86% of patients with HRS.The survey was administered to 35 clinicians. Incorrect response rates were high in key domains: early management of AKI in cirrhosis (82.9%), MHRA terlipressin guidance (63.3%), and ICA diagnostic criteria (52.9%).Conclusions AKI in CLD is associated with a high rate of in-hospital mortality and poor outcomes. Despite current safety guidance, terlipressin use in MHRA high-risk patients remains inconsistent. Important knowledge gaps in key areas of AKI management in cirrhosis could be contributing to deviations from recommended practice. Targeted multidisciplinary education and integration of nephrology expertise could improve adherence to guidance and optimise patient outcomes.