Frequency, pattern and short-term outcome of chronic renal dysfunction in patients with cirrhosis: a prospective study employing HRS and ADOJ-IAC criteria

Abstract

INTRODUCTION AND OBJECTIVES: 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 (ADOJ-IAC), we studied the frequency, pattern and short-term outcome of CRD in patients with cirrhosis, using both HRS2 and ADQJ-IAC criteria. METHODS: Consecutive patients with cirrhosis and stable serum creatinine (SCr) for 3 months or more attending outpatient clinics in Colombo North Teaching Hospital, Ragama, were prospectivefy recruited and followed up. RESULTS: Of 277 patients with cirrhosis and stable SCr, 23 (8.3%) fulfilled criteria for HRS2. 65/277 (23.5%) had eGFR<60ml/min/1.73m2 [ADOJ-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). 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. Based on a multiple regression model Child-Turcotte:Pugh (CTP) class and CRD were significantly associated with death. After correcting for CTP class, both HRS2 (OR 4.56, 95%CI 1.79-11.53) and Non-HRS2 CKD (OR 2.19, 95%CI 1.02-4.68) were independently associated with death. CONCLUSIONS: Compared to HRS2 criteria, eGFR<60mI/min/1.73m2 detected almost twice the number of cirrhotics with CRD. Patients with eGFR<60ml/min/1.73m2 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.