Un-precipitated acute kidney injury is uncommon among stable patients with cirrhosis and ascites.

Abstract

BACKGROUND & AIMS:

Acute episodes of renal dysfunction or acute kidney injury (AKI) in cirrhotic patients with ascites are mostly precipitated by an acute event. The prevalence of un-precipitated AKI in stable ascitic cirrhotic patients is unknown. The aims of this study were to determine (i) the prevalence of un-precipitated AKI in stable cirrhotics with ascites and (ii) any predictive factors for its development.

METHODS:

A total of 1115 stable cirrhotic patients with mild liver and renal dysfunction but varying degrees of ascites severity from 3 previous satavaptan vs placebo randomized controlled trials (Group A, ascites requiring diuretics but not paracentesis; Group B, ascites requiring frequent paracentesis; Group C, refractory ascites) were included. AKI was diagnosed when there was either an increase of ≥0.3 mg/dL in ≤48 hours or a 50% increase in serum creatinine, and staged according to the fold increase of the serum creatinine. Two serum creatinine levels measured maximally 7 days apart at screening and at randomization of the satavaptan studies with no acute intervening events were used.

RESULTS:

The prevalence of un-precipitated AKI was 1.8% overall, with the prevalence rising with increasing severity of ascites. Ninety-five per cent of cases were stage 1, with 15% progression rate, 3 reaching the severity of type 1 acute hepatorenal syndrome. Ascites severity was the most powerful predictor for un-precipitated AKI development, which did not predict overall mortality.

CONCLUSIONS:

Increased prevalence of AKI with more severe ascites despite minimal baseline liver and renal dysfunction suggests that frequent monitoring of renal function in these patients is mandatory.

• Authors: Florence Wong, Peter Jepsen, Hugh Watson, Hendrik Vilstrup
• Journal: Liver international : official journal of the International Association for the Study of the Liver (Liver Int) Vol. 38 Issue 10 Pg. 1785-1792 (10 2018) ISSN: 1478-3231 [Electronic] United States
• PMID: 29532591 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Diuretics
• Morpholines
• Spiro Compounds
• satavaptan
• Creatinine

Topics

• Acute Kidney Injury (diagnosis, etiology)
• Aged
• Ascites (complications, therapy)
• Creatinine (blood)
• Diuretics (therapeutic use)
• Female
• Humans
• Internationality
• Liver Cirrhosis (complications, therapy)
• Male
• Middle Aged
• Morpholines (therapeutic use)
• Paracentesis
• Prognosis
• Proportional Hazards Models
• Severity of Illness Index
• Spiro Compounds (therapeutic use)