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Am J Kidney Dis. 2016 Sep;68(3):381-91. doi: 10.1053/j.ajkd.2016.02.041. Epub 2016 Mar 16.

Changes in Kidney Function After Transjugular Intrahepatic Portosystemic Shunts Versus Large-Volume Paracentesis in Cirrhosis: A Matched Cohort Analysis.

Author information

1
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA. Electronic address: aallegretti@partners.org.
2
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
3
Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Boston, MA.
4
Department of Radiology, Massachusetts General Hospital, Boston, MA.

Abstract

BACKGROUND:

Patients with cirrhosis and refractory ascites have physiologic and hormonal dysregulation that contributes to decreased kidney function. Placement of a transjugular intrahepatic portosystemic shunt (TIPS) can reverse these changes and potentially improve kidney function. We sought to evaluate change in estimated glomerular filtration rate (eGFR) following TIPS placement.

STUDY DESIGN:

Retrospective, matched cohort analysis.

SETTINGS & PARTICIPANTS:

Patients who underwent first-time TIPS placement for refractory ascites in 1995 to 2014. Frequency matching was used to generate a comparator group of patients with cirrhosis and ascites treated with serial large-volume paracentesis (LVP) in a 1:1 fashion.

PREDICTOR:

TIPS placement compared to serial LVP.

OUTCOME:

Change in eGFR over 90 days' follow-up.

MEASUREMENTS:

Multivariable regression stratified by baseline eGFR<60 versus ≥60mL/min/1.73m(2); analysis of effect modification between TIPS placement and baseline eGFR.

RESULTS:

276 participants (TIPS, n=138; serial LVP, n=138) were analyzed. After 90 days, eGFRs increased significantly after TIPS placement in participants with baseline eGFRs<60mL/min/1.73m(2) compared to treatment with serial LVP (21 [95% CI, 13-29] mL/min/1.73m(2); P<0.001) and was no different in those with eGFRs≥60mL/min/1.73m(2) (1 [95% CI, -9 to 12] mL/min/1.73m(2); P=0.8). There was significant effect modification between TIPS status and baseline eGFR (P=0.001) in a model that included all participants.

LIMITATIONS:

Outcomes restricted by clinically recorded data; clinically important differences may still exist between the TIPS and LVP cohorts despite good statistical matching.

CONCLUSIONS:

TIPS placement was associated with significant improvement in kidney function. This was most prominent in participants with baseline eGFRs<60mL/min/1.73m(2). Prospective studies of TIPS use in populations with eGFRs<60mL/min/1.73m(2) are needed to evaluate these findings.

KEYWORDS:

TIPS placement; Transjugular intrahepatic portosystemic shunt (TIPS); cirrhosis; estimated glomerular filtration rate (eGFR); kidney; large-volume paracentesis (LVP); liver; mortality; portal hypertension; refractory ascites; renal function

PMID:
26994685
PMCID:
PMC5002241
DOI:
10.1053/j.ajkd.2016.02.041
[Indexed for MEDLINE]
Free PMC Article

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