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Liver Transpl. 2019 Mar 25. doi: 10.1002/lt.25454. [Epub ahead of print]

Impact of Chronic Kidney Disease on Outcomes in Cirrhosis.

Author information

1
University of Toronto, Toronto, Ontario, Canada.
2
University of Pennsylvania, Philadelphia, Pennsylvania, USA.
3
VA Medical Center, Dallas, Texas, USA.
4
University of Alberta, Edmonton, Alberta, Canada.
5
University of Washington, Seattle, Washington, USA.
6
Yale University School of Medicine, New Haven, Connecticut, USA.
7
University of Tennessee, Knoxville, Tennessee, USA.
8
University of California, San Francisco, California, USA.
9
University of Arizona, Tucson, Arizona, USA.
10
Mayo Clinic Arizona, Phoenix, Arizona, USA.
11
Emory University, Atlanta, Georgia, USA.
12
Mercy Medical Center, Baltimore, Maryland, USA.
13
Mayo Clinic, Rochester, Minnesota, USA.
14
Department of Statistics, Commonwealth University of Virginia, Richmond, Virginia, USA.
15
Commonwealth University of Virginia and McGuire VA Medical Center, Richmond, Virginia, USA.

Abstract

BACKGROUND & AIM:

We hypothesize that the prevalence of chronic kidney disease (CKD) amongst cirrhotic patients has increased due to increased prevalence of CKD associated co-morbidities such as diabetes. We aimed to assess the characteristics of hospitalized cirrhotic patients with CKD and its impact on renal and patient outcomes.

METHODS:

The North American Consortium for the Study of End-Stage Liver Disease (NACSELD) prospectively enrolled non-electively admitted cirrhotic patients and collected data on demographics, laboratory results, in-hospital clinical course, and post-discharge 3-month outcomes. Patients with CKD (CKD+), defined as eGFR (MDRD4 formula) of ≤60ml/min for >3 months, were compared with those without (CKD-) for development of organ failures, hospital course, and survival.

RESULTS:

1,099 CKD+ patients (46.8% of 2,346 enrolled patients) had significantly higher serum creatinine (2.21±1.33 vs. 0.83±0.21mg/dL in CKD-) on admission, higher prevalence of non-alcoholic steatohepatitis cirrhosis etiology, diabetes, refractory ascites and hospital admissions in previous 6 months compared to CKD- group (all p<0.001). Propensity matching (n=922 in each group) by Child-Pugh scores (9.78±2.05 vs. 9.74±2.04, p>0.05) showed that CKD+ patients had significantly higher rates of superimposed acute kidney injury (AKI) (68% vs. 21%; p<0.001) and eventual need for dialysis (11% vs. 2%; p<0.001) than CKD- patients. CKD+ patients also had more cases of acute-on-chronic liver failure as defined by the NACSELD group, associated with reduced 30- and 90-day overall survival (P<0.001 for both). A 10ml/min drop in eGFR was associated with a 13.1% increase in risk for 30-day mortality.

CONCLUSION:

Patients with CKD should be treated as a high-risk group among hospitalized cirrhotic patients due to their poor survival and monitored carefully for the development of superimposed AKI. This article is protected by copyright. All rights reserved.

KEYWORDS:

Acute kidney injury; Bacterial infection; Delta creatinine; Estimated glomerular filtration rate; Organ failure

PMID:
30908855
DOI:
10.1002/lt.25454

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