Gastroenterology

Gastroenterology

Volume 140, Issue 2, February 2011, Pages 488-496.e4
Gastroenterology

Clinical—Liver, Pancreas, and Biliary Tract
Prognostic Importance of the Cause of Renal Failure in Patients With Cirrhosis

https://doi.org/10.1053/j.gastro.2010.07.043Get rights and content

Background & Aims

The prognostic value of the different causes of renal failure in cirrhosis is not well established. This study investigated the predictive value of the cause of renal failure in cirrhosis.

Methods

Five hundred sixty-two consecutive patients with cirrhosis and renal failure (as defined by serum creatinine > 1.5 mg/dL on 2 successive determinations within 48 hours) hospitalized over a 6-year period in a single institution were included in a prospective study. The cause of renal failure was classified into 4 groups: renal failure associated with bacterial infections, renal failure associated with volume depletion, hepatorenal syndrome (HRS), and parenchymal nephropathy. The primary end point was survival at 3 months.

Results

Four hundred sixty-three patients (82.4%) had renal failure that could be classified in 1 of 4 groups. The most frequent was renal failure associated with infections (213 cases; 46%), followed by hypovolemia-associated renal failure (149; 32%), HRS (60; 13%), and parenchymal nephropathy (41; 9%). The remaining patients had a combination of causes or miscellaneous conditions. Prognosis was markedly different according to cause of renal failure, 3-month probability of survival being 73% for parenchymal nephropathy, 46% for hypovolemia-associated renal failure, 31% for renal failure associated with infections, and 15% for HRS (P < .0005). In a multivariate analysis adjusted for potentially confounding variables, cause of renal failure was independently associated with prognosis, together with MELD score, serum sodium, and hepatic encephalopathy at time of diagnosis of renal failure.

Conclusions

A simple classification of patients with cirrhosis according to cause of renal failure is useful in assessment of prognosis and may help in decision making in liver transplantation.

Section snippets

Study Population

All consecutive patients with cirrhosis and renal failure hospitalized at the Liver Unit of the Hospital Clínic of Barcelona from January 2002 to September 2008 were included in a prospective study aimed at investigating the causes of renal failure in cirrhosis and their relationship with prognosis. Patients admitted for complications of cirrhosis as well as for conditions unrelated to liver disease that had renal failure at admission or developed renal failure during hospitalization were

Causes of Renal Failure: Prevalence and Characteristics of Patients

Five hundred sixty-two consecutive hospitalized patients with cirrhosis and renal failure were identified during the study period. Four hundred sixty-three patients (82.4%) were classified into the 4 prespecified categories of renal failure. The most frequent cause was renal failure associated with infections (213 patients; 46%), followed by hypovolemia-related renal failure (149; 32%), HRS (60, 13%), and parenchymal nephropathy (41, 9%). The remaining patients could not be classified into 1 of

Discussion

The current study reports the largest prospective investigation of renal failure in cirrhosis and provides information on the causes of renal failure in hospitalized cirrhotic patients and its relationship with prognosis. The most frequent causes of renal failure were infections followed by conditions associated with volume depletion, both accounting for almost two-thirds of all cases. Infections are a well-documented cause of renal failure in cirrhosis.1, 2, 3, 12, 13, 14 In most cases, renal

Acknowledgments

The authors thank Raquel Cela, RN, and the nursing staff of the Liver Unit and Intensive Care Unit for their participation in the study.

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    Conflicts of interest The authors disclose no conflicts.

    Funding This work was supported by a grant from Fondo de Investigación Sanitaria (FIS PI080126; to P.G.) and a grant from Premio Fundación Lilly de Investigación Biomédica Clínica (to J.R.). M.M.–L. and G.P. were supported by grants from the Fundación Banco de Bilbao-Vizcaya-Argentaria (FBBVA). C.F. was supported by a grant from Instituto Reina Sofía de Investigación Nefrológica. CIBEREHD is funded by the Instituto de Salud Carlos III.

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