Royal Free Hospital-estimated glomerular filtration rate for prognostic stratification of first acute kidney injury in cirrhosis.

Rodrigues, Susana G; Abraldes, Juan G; Tsochatzis, Emmanouil; Bosch, Jaime; Berzigotti, Annalisa (2021). Royal Free Hospital-estimated glomerular filtration rate for prognostic stratification of first acute kidney injury in cirrhosis. Liver international, 41(4), pp. 819-827. Wiley 10.1111/liv.14765

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BACKGROUND & AIMS

Renal function is a major determinant of prognosis in patients with cirrhosis. Current guidelines only contemplate serum creatinine (sCr) to assess kidney injury. However, there are formulas to estimate glomerular filtration rate (eGFR) which better measure renal function in patients listed for liver transplantation. There is no data available on whether these formulas predict prognosis in patients with acute kidney injury (AKI).

METHODS

In 143 patients presenting with a first episode of AKI, we compared the prognostic value of renal function estimated using sCr or eGFR assessed with Modification of Diet in Renal Disease (MDRD-6), chronic kidney disease epidemiology (CKD-EPI) and Royal Free Hospital (RFH) for renal replacement therapy (RRT) within 30 days of AKI, and 30- and 90-day transplant-free survival.

RESULTS

eGFR was calculated on values obtained before and at admission, at presentation of AKI (D0) and 48 hours after AKI (D2).15% of patients (more commonly in alcohol+metabolic etiology; p=0.049 vs. other) required RRT. Transplant-free survival at 30-and 90-day were 77% and 63%. Among sCr, MDRD-6, CKD-EPI and RFH-eGFR, the latter predicted best RRT (HR .937 95% CI .893-.982, p=0.007), 30-d (HR .936 95% CI .901-.972, p=0.001) and 90-d (HR .934 95% CI .908-.972, p<0.001) mortality/OLT.

CONCLUSIONS

Renal function estimated using the RFH-eGFR calculated at D2 after AKI diagnosis is a strong predictor of RRT and of 30-d and 90-d transplant-free survival. Results suggest that in cirrhosis, RFH-eGFR may be a better indicator of prognosis in AKI than sCr.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie

UniBE Contributor:

Gomes Rodrigues, Susana; Bosch, Jaime and Berzigotti, Annalisa

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1478-3231

Publisher:

Wiley

Language:

English

Submitter:

Rahel Fuhrer

Date Deposited:

18 Dec 2020 16:07

Last Modified:

19 Mar 2021 01:32

Publisher DOI:

10.1111/liv.14765

PubMed ID:

33314543

Uncontrolled Keywords:

advanced chronic liver disease chronic kidney disease hepatorenal syndrome

BORIS DOI:

10.7892/boris.149673

URI:

https://boris.unibe.ch/id/eprint/149673

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