Renal dysfuction in patients with cirrhosis - a prospective analysis

Abstract

INTRODUCTION: Renal dysfunction in cirrhosis has been shown to increase the risk of death seven-fold. Current definitions fail to detect milder degrees of renal dysfunction and exclude hepatorenal syndrome types 1 and 2 (HRS 1 and 2) in patients who have structural kidney diseases. Both have therapeutic implications; delayed diagnosis leading to a worse prognosis and withholding of treatments with potential benefit (eg. TIPPS, vasoconstrictors). Definitions that address these issues have been proposed [cirrhosis with acute kidney injury (AKI), chronic kidney disease (CKD) and acute-on-chronic kidney disease (ACKD)]. AIMS: To study frequency and pattern of renal dysfunction in cirrhotic patients using the newly proposed definitions METHODS: Consecutive patients with cirrhosis attending outpatient clinics were prospectively recruited from 01/08/2011 to 15/03/2012. Clinical data were obtained and renal functions were tested. Results: Of 166 patients with cirrhosis 17(10.2%) had serum creatinine >1.5 mg/dL (current cut-off), and 13/17(76.5%) fulfilled criteria of HRS 2. However, 49/166(29.5%) had eGFR <60 mg/dl (proposed cut-off), but 36/49(73.4%) did not fulfill criteria for HRS. 27/36(75%) had type II diabetes mellitus, 12/36(33.3%) had hypertension and 7/36(19.4%) had no co-morbidities. During the study period, 36/166 patients required admission; 12/36(33.3%) due to acute renal dysfunction (a rise of serum creatinine >0.3mg/dl within 48 hours). 6/12(50%) fulfilled criteria for HRS 1. Of the others, 4/6 had normal renal function and 2/6 had non-HRS CKD prior to admission. CONCLUSIONS: Our results suggest that current definitions fail to detect many cirrhotic patients with renal dysfunction. The proposed criteria seem more inclusive.