30May 2019

RISK STRATIFICATION AND 90 DAYS OUTCOME OF IMPAIRMENT OF KIDNEY FUNCTION IN PATIENTS WITH CIRRHOSIS BY CAUSES AND REVISED CONSENSUS BY INTERNATIONAL CLUB OF ASCITES.

  • Lecturer in Gastroenterology Department,DeenanathMangeshkar Hospital ,Pune 411004 (Ex senior resident Nizams Institute of health sciences,Hyderabad 500082.
  • Junior resident MGM Medical College Navi Mumbai.
  • Senior resident Department of Gastroenterology Nizams Institute of health sciences,Hyderabad.
  • Ex Head of department Department of Gastroenterology Nizams Institute of health sciences,Hyderabad.
Crossref Cited-by Linking logo

  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Introduction: Cirrhotic patients with acute renal failure have poor survival. We aimed to examine the association between type of acute kidney injury, cause and 90-day survival. Methods: This was a prospective observational study in a tertiary centre of consecutive patients admitted with cirrhosis and renal dysfunction in a tertiary centre. They were classified according to revised consensus and by the cause of renal failure: renal failure associated with infections; hypovolemia; hepatorenal syndrome (HRS) and parenchymal nephropathy. The primary end point was survival at 90 days. Results: Total 112 patients had acute kidney injury during the study period from 1st January 2016 to 31st December 2016. Renal dysfunction associated with infection (49.1%) was most common cause followed by hypovolemia (28.7%), HRS (18.7%) and parenchymal renal diseases (3.5%). Progression of renal dysfunction was seen in HRS group (14/21, 53.8%), followed by infection (20%), hypovolemia (6%) and parenchymal renal disease (0%). Complete response to treatment was seen in hypovolemia group (18/29, 62%) followed by infection (25/50, 50%), parenchymal disease (2/4, 50%) and HRS (0%) in decreasing order. HRS was associated with high mortality at 90 days (20/21, 95%), followed by infection (56%), hypovolemia (41%) and parenchymal renal diseases (25%). Progression of renal dysfunction is independently associated with mortality. Conclusion: The results of the current study confirm that acute kidney injury, as defined by International Club of Ascites, is associated with high 90 days mortality. Similarly classification by cause of renal dysfunction can predict mortality and outcome.

  1. Angeli P, Gines P, Wong F, Bernardi M, Boyer TD, Gerbes A, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Journal of Hepatology. 2015 Apr;62(4):968-74.
  2. Carvalho GC, Regis Cde A, Kalil JR, et al. Causes of renal failure in patients with decompensated cirrhosis and its impact in hospital mortality. Annals of Hepatology 2012;11(1):90-95.
  3. Martin-Llahi M, Guevara M, Torre A, et al. Prognostic importance of the cause of renal failure in patients with cirrhosis. Gastroenterology 2011;140(2):488-496.
  4. Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology. 2008; 48(6):2064?2077.
  5. Wong F, O?Leary JG, Reddy KR, Patton H, Kamath PS, Fallon MB, et al. New consensus definition for acute kidney injury accurately pre?dicts 30-day mortality in cirrhosis with infection. Gastroenterology 2013;145:1280-1288.84.
  6. Follo A, Llovet JM, Navasa M, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology 1994;20:1495?1501.
  7. AngeliP,Rodr?guez E, Piano S, et al. Acute kidney injury and acute-on-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis.Gut 2015;64:1616?1622.
  8. Salerno F, Borroni G, Moser P, Badalamenti S, Cassara L, Maggi A, etal. Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 out patients. American Journal Gastroenterology 1993;88:514-19.
  9. Watt K, Uhanova J, Minuk GY. Hepatorenal syndrome: diagnostic accuracy, clinical features and outcome in a tertiary care center. American Journal Gastroenterology 2002;97(8):1868-70.
  10. Gin?s P, Cardenas A, Arroyo V, et al. Management of cirrhosis and ascites. New England Journal of Medicine 2004;350:1646?1654.
  11. Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. New England Journal of Medicine 1999;341:403?409.
  12. Fang JT, Tsai MH, Tian YC, Jenq CC, Lin CY, Chen YC, et al. Outcome predictors and new score of critically ill cirrhotic patients with acute renal failure. Nephrology Dialysis Transplant.2008; 23(6):1961?1969.
  13. Schepke, B. Appenrodt, J. Heller, J. Zielinski, and T. Sauerbruch, Prognostic factors for patients with cirrhosis and kidney dysfunction in the era of MELD: results of a prospective study. Liver International, 2006;26: 834?839.
  14. Carvalho JR, Villela-Nogueira CA, Luiz RR, et al. Acute kidney injury network criteria as a predictor of hospital mortality in cirrhotic patients with ascites. Journal Clinical Gastroenterology 2011 ;46(3):e21-6.
  15. Belcher JM, Garcia-Tsao G, Sanyal AJ, et al. Association of AKI with mortality and complications in hospitalized patients with cirrhosis. Hepatology 2013;57(2):753-762.
 

[Rishabh Prakash Jain, Parul Jain, Vineet Chaudari, Ravichandra NS and Ajit kumar. (2019); RISK STRATIFICATION AND 90 DAYS OUTCOME OF IMPAIRMENT OF KIDNEY FUNCTION IN PATIENTS WITH CIRRHOSIS BY CAUSES AND REVISED CONSENSUS BY INTERNATIONAL CLUB OF ASCITES. Int. J. of Adv. Res. 7 (May). 1382-1388] (ISSN 2320-5407). www.journalijar.com

Dr Rishabh Prakash Jain
Lecturer in Gastroenterology Department,Deenanath Mangeshkar Hospital ,Pune 411004

DOI:

Article DOI: 10.21474/IJAR01/9178      
DOI URL: https://dx.doi.org/10.21474/IJAR01/9178

Download Full Paper

Download PDF No. of Downloads: 8 | No. of Views: 61