Impact of Chronic Kidney Disease on Outcomes in Cirrhosis.
Liver Transpl. 2019 Mar 25;:
Authors: Wong F, Reddy RK, O'Leary JG, Tandon P, Biggins SW, Garcia-Tsao G, Maliakkal BJ, Lai JC, Fallon MB, Vargas HE, Subramanian R, Thuluvath PJ, Kamath PS, Thacker L, Bajaj JS
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.
PMID: 30908855 [PubMed - as supplied by publisher]