Frequency, pattern and short-term outcome of chronic renal dysfunction in patients with cirrhosis

Abstract

OBJECTIVE: Current criteria fail to detect milder degrees of renal dysfunction in cirrhosis, and exclude hepatorenal syndrome (HRS1, HRS2) in patients with structural kidney disease. Definitions addressing this have been proposed by Working Party of the Acute Dialysis Quality Initiative and International Ascites Club (ADQI-IAC). We studied the frequency, pattern and outcome of renal dysfunction in patients with cirrhosis using ADQI-IAC definitions. METHODS: 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 >1.5 mg/dl (current cut-off), and 23/27 (85%) fulfilled criteria for HRS2. 65/277 (23.5%) had eGFR <60 ml/min [ADQI-IAC cut-off for chronic kidney disease (CKD)], but 42/65 (64.6%) did not fulfil criteria for HRS2. Compared to cirrhotics without CKD, the CKD group were older (61.4 vs 53.7 years; p < 0.0001), more likely to be female (50.8% vs 19.3%; p < 0.0001), more likely to have cryptogenic cirrhosis (67.7% vs 41%; p < 0.0001), and Child-Pugh class B or C (95.4% vs 74%; p < 0.001). As expected, they had higher MELD scores (16.6 vs 13.5; p < 0.0001). 58/277 (20.9%) died during follow-up [mean 9.8 months (SD 4.5)]. After adjusting for other variables, CKD independently increased risk of death 3.3-fold (Nagelkerke R Square test). CONCLUSION: Compared to HRS criteria, the ADQI-IAC definition detects more than twice the number of cirrhotic patients with CKD. As the presence of CKD is associated with increased mortality, further studies are needed to determine whether prognosis can be improved in such patients by treating acute deterioration of CKD with available treatments for HRS1.