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Multicenter Study
. 2019 Oct;17(11):2364-2370.
doi: 10.1016/j.cgh.2019.01.043. Epub 2019 Feb 1.

Association Between Renal Function Pattern and Mortality in Patients With Cirrhosis

Giuseppe Cullaro  1 , Elizabeth C Verna  2 , Jennifer C Lai  3
Affiliations
Multicenter Study

Association Between Renal Function Pattern and Mortality in Patients With Cirrhosis

Giuseppe Cullaro et al. Clin Gastroenterol Hepatol. 2019 Oct.

Abstract

Background & aims: Renal dysfunction increases risk of death for patients with cirrhosis. We investigated whether mortality differs significantly among patients with acute kidney injury (AKI), chronic kidney disease (CKD), and both.

Methods: We performed a retrospective analysis of all non-status 1 adults on the waitlist for liver transplantation for at least 90 days, collected from the Organ Procurement and Transplantation Network registry from July 1, 2007 through July 1, 2014. We assigned patients to groups of AKI (an increase of ≥0.3 mg/dL or ≥50% in serum creatinine in the last 7 days or fewer than 72 days of hemodialysis), CKD (an estimated glomerular filtration rate <60 ml/min/1.73 m2 for 90 days with a final rate ≥30 ml/min/1.73 m2 or ≥72 days of hemodialysis), AKI and CKD (meet both definitions), or normal (meet neither definition). We performed competing risk analyses to associate patterns of renal dysfunction with waitlist mortality, accounting for liver transplantation, with renal pattern as a time-dependent covariate. Logistic regression for 6-month mortality determined the added benefit of including renal function pattern in the assessment.

Results: There were 22,680 patients in the cohort; they spent a median 1.6 years (range, 0.7-3.1 years) on the waitlist and a median 5 years (range, 2-9 years) undergoing assessments of renal function. In competing risk analysis, even after adjusting for confounders including final model for end-stage liver disease sodium (MELD-Na) scores, the pattern of renal function was significantly associated with waitlist mortality: AKI and CKD (subhazard ratio [SHR], 2.86; 95% CI, 2.65-3.10), AKI (SHR, 2.42; 95% CI 2.22-2.64), CKD (SHR, 1.56; 95% CI, 1.45-1.67) compared with normal. The area under the curve values, based on MELD-Na score at time of placement on the waitlist, were 0.80 with renal function pattern and 0.71 without (P < .001).

Conclusion: In competing risk analysis, even after adjusting for confounders including final MELD-Na score, we found the pattern of renal dysfunction to associate with mortality in patients with cirrhosis. Including information on type of renal dysfunction could improve risk analysis.

Keywords: Liver Disease; Liver Transplantation; Renal Dysfunction; Waitlist Mortality.

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Conflict of interest statement

Disclosures: The authors of this manuscript have conflicts of interest to disclose as described by Gastroenterology: Giuseppe Cullaro – nothing to disclose. Elizabeth C. Verna – Advisory Committees or Review Panels: Gilead; Grant/Research Support: Salix, Merck. Jennifer C. Lai – nothing to disclose.

Figures

Figure 1.
Figure 1.
Flow Diagram with Definitions of Renal Patterns
Figure 2.
Figure 2.
Cumulative Incidence Curve for Waitlist Mortality by Renal Function Pattern
Figure 3.
Figure 3.. Contrasts of Adjusted Mean Subhazard Ratio in Reference to CKD at Varying Final MELDNa Scores
Error bars represent 95% Confidence Intervals
See this image and copyright information in PMC

Comment in

References

    1. Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology. 2008;48(6):2064–77. - PubMed
    1. Cullaro G, Park M, Lai JC. “Normal” Creatinine Levels Predict Persistent Kidney Injury and Waitlist Mortality in Outpatients with Cirrhosis. Hepatology [Internet]. 2018. April 26 [cited 2018 Jun 22]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/29698588 - PMC - PubMed
    1. Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet [Internet]. 2014. May 17 [cited 2018 Jun 8];383(9930):1749–61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24480518 - PubMed
    1. Ginès P, Schrier RW. Renal Failure in Cirrhosis. N Engl J Med [Internet]. 2009. September 24 [cited 2017 Nov 4];361(13):1279–90. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMra0809139 - DOI - PubMed
    1. Fede G, D’amico G, Arvaniti V, Tsochatzis E, Germani G, Georgiadis D, et al. Renal failure and cirrhosis: A systematic review of mortality and prognosis. J Hepatol [Internet]. 2012. [cited 2018 Jun 21];56:810–8. Available from: https://ac.elscdn.com/S0168827811008531/1-s2.0-S0168827811008531-main.pd... - PubMed

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