Frequency, pattern and outcome of renal dysfunction in patients with cirrhosis: a prospective study using the proposed ADQI-IAC criteria

Abstract

INTRODUCTION AND OBJECTIVES: Current criteria fail to detect milder degrees of renal dysfunction in cirrhosis, and exclude hepatorenal syndrome (HRS1 and 2) in patients who have structural kidney disease. Definitions addressing these issues have been proposed by a working party from the Acute Dialysis Quality Initiative and International Ascites Club (ADQI-IAC). METHODS: We studied the frequency, pattern and outcome of renal dysfunction in patients with cirrhosis using ADQI-IAC definitions. Consecutive patients attending outpatient clinics in Colombo North Teaching Hospital, Ragama, were prospectively recruited and followed up.RESULTS: Of 277 patients with cirrhosis and stable serum creatinine, 27 (9.7%) had serum creatinine >1.5mg/dl (current cut-off), and 23/27 (85%) fulfilled criteria for HRS2. 65/277 (23.5%) had eGFR<60ml/min [ADQI-IAC cut-off for chronic kidney disease (CKD)], but 42/65 (64.6%) did not fulfill criteria for HRS2. Compared to cirrhotics without CKD, the CKD group were older (61.4 vs 53.7 years; pO.OOOl), more likely to be female (50.8% vs 19.3%; p0.000l), had cryptogenic cirrhosis (67.7% vs 41%; pO.OOOl), and were Child-Pugh class B or C (95.4% vs 74%; p0.00l). As expected, they had higher MELD scores (16.6 vs 13.5; p<0.0001). 48/277 (17.3%) died during follow-up [mean 6.5 months (SD 2.2)]; an eGFR<60ml/min independently increased risk of death (HR 2.7; Nagelkerke R Square test). CONCLUSIONS: Compared to HRS criteria, the ADQI-IAC definition detects more than twice the number of cirrhoric patients with CKD. As CKD is associated with increased mortality, further study is needed to determine whether prognosis can be improved by treating acute deterioration of CKD with available treatments for HRS 1.