Abstract:
BACKGROUND: Diagnostic criteria of hepatorenal syndrome type 2 (HRS2) fail to detect milder degrees of chronic renal dysfunction (CRD) in cirrhosis and exclude patients with pre-existing kidney disease. Definitions addressing this have been proposed by Working Party of the Acute Dialysis Quality Initiative and International Ascites Club (ADQI-IAC). AIMS: We studied the frequency, pattern and short-term outcome of CRD in patients with cirrhosis, using both HRS2 and ADQI-IAC criteria. PATIENTS AND METHODS: Consecutive patients with cirrhosis and stable serum creatinine for 3 months or more attending outpatient clinics in Colombo North Teaching Hospital (Ragama, Sri Lanka) were prospectively recruited and followed up. RESULTS: Of 277 patients with cirrhosis and stable serum creatinine, 23 (8.3%) fulfilled criteria for HRS2, and 65/277 (23.5%) had estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m [ADQI-IAC definition of chronic kidney disease (CKD)]. This included the 23 patients with HRS2 and an additional 42/65 (64.6%) who did not fulfil diagnostic criteria for HRS2 (non-HRS2 CKD). In all, 58/277 (20.9%) died during follow-up [mean 9.8 months (SD 4.5)]. This included 12/23 (52.2%) with HRS2 and 14/42 (33.3%) with non-HRS2 CKD. On the basis of multiple regression model, Child-Turcotte-Pugh class and CRD were significantly associated with death. After correcting for Child-Turcotte-Pugh class, both HRS2 (odds ratio 4.56, 95% confidence interval 1.79-11.53) and non-HRS2 CKD (odds ratio 2.19, 95% confidence interval 1.02-4.68) were independently associated with death. CONCLUSION: Compared with HRS2 criteria, eGFR less than 60 ml/min/1.73 m detected almost twice the number of cirrhotics with CRD. Patients with eGFR less than 60 ml/min/1.73 m who did not fulfil criteria for HRS2 also had significant short-term mortality. ADQI-IAC criteria thus appear to be a more useful definition of CRD in cirrhotics.