Beyond serum creatinine: which tools to evaluate renal function in cirrhotic patients?

Carrier, Paul; Debette-Gratien, Marilyne; Essig, Marie; Loustaud‐Ratti, Véronique

doi:10.1111/hepr.13224

Cited by 11 publications

(6 citation statements)

References 53 publications

(68 reference statements)

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“…Despite wide use, changes in serum creatinine or estimated glomerular filtration rate (eGFR) in isolation may not be sensitive enough to predict the degree or course of renal injury, particularly in patients with cirrhosis and malnutrition . Measured GFR (mGFR) is much more accurate but impractical and costly to implement into serial clinical practice.…”

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confidence: 99%

External Validation of a Pretransplant Biomarker Model (REVERSE) Predictive of Renal Recovery After Liver Transplantation

et al. 2019

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In patients with end-stage liver disease, the ability to predict recovery of renal function following liver transplantation (LT) remains elusive. However, several important clinical decisions depend on whether renal dysfunction is recoverable after LT. We used a cohort of patients undergoing LT to independently validate a published pre-LT model predictive of post-transplant renal recovery (Renal Recovery Assessment at Liver Transplant [REVERSE]: high osteopontin [OPN] and tissue inhibitor of metalloproteinases-1 [TIMP-1] levels, age < 57, no diabetes). Serum samples pre-LT and 4-12 weeks post-LT (n = 117) were analyzed for kidney injury proteins from three groups of recipients: (1) estimated glomerular filtration rate (eGFR) < 30 mL/minute/1.73 m 2 prior to and after LT (irreversible acute kidney injury [AKI]), (2) eGFR < 30 mL/minute/1.73 m 2 prior to LT and >50 mL/minute/1.73 m 2 after LT (reversible AKI [rAKI]) (3) eGFR > 50 mL/minute/1.73 m 2 prior to and after LT (no AKI). In patients with elevated pre-LT serum levels of OPN and TIMP-1, recovery of renal function correlated with decreases in the level of both proteins. At 4 weeks post-LT (n = 77 subset), the largest decline in OPN and TIMP-1 was seen in the rAKI group. Validation of the REVERSE model in this independent data set had high area under the curve (0.78) in predicting full post-LT renal recovery (sensitivity 0.86, specificity 0.6, positive predictive value 0.81, negative predictive value 0.69). Our eGFR findings were confirmed using measured GFR. Conclusion: The REVERSE model, derived from an initial training set combining plasma biomarkers and clinical characteristics, demonstrated excellent external validation performance characteristics in an independent patient cohort using serum samples. Among patients with kidney injury pre-LT, the predictive ability of this model may prove beneficial in clinical decision-making both prior to and following transplantation. (Hepatology 2019;70:1349-1359).A cute kidney injury (AKI) is common among patients with decompensated liver disease awaiting liver transplantation (LT) alone and is associated with a 7-fold increase in mortality. (1) Pretransplant renal dysfunction, particularly if not reversible after LT, is also an important predictor of chronic kidney disease (CKD), morbidity, and mortality after LT. (2)(3)(4)(5) Accurate assessment of reversibility of pre-LT renal injury is important for several reasons. First, identification of patients with

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confidence: 99%

External Validation of a Pretransplant Biomarker Model (REVERSE) Predictive of Renal Recovery After Liver Transplantation

et al. 2019

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“…44 55 56 Precise estimation of kidney function by radio-isotopes prevents overestimation of kidney function in cirrhotic patients, however, they are expensive, time-consuming, and not clinically used. 57…”

Section: Intra-abdominal Hypertension and Renal Hypo-perfusionmentioning

confidence: 99%

“…44,55,56 Precise estimation of kidney function by radio-isotopes prevents overestimation of kidney function in cirrhotic patients, however, they are expensive, time-consuming, and not clinically used. 57 Renal functional reserve is defined as the difference between stress and baseline GFR. It represents the kidney capacity to increase GFR in response to various stimuli/challenges.…”

Section: Evaluation Of Kidney Function In Cirrhotic Patientsmentioning

confidence: 99%

Renal Dysfunction in Patients with Liver Cirrhosis

Sobh

Abdalbary

Abdelsalam

et al. 2022

Digestive Disease Interventions

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Liver cirrhosis is a major health problem that can affect people of different ages. It induces pivotal hemodynamic and metabolic systemic disturbances along with other organs dysfunction. Renal dysfunction in cirrhotic patients is not uncommon, and subtle renal impairment is an early and very frequent finding. Liver cirrhosis can afflict kidney functions through different mechanisms. Renal vasoconstriction is usually the initial response of splanchnic vasodilation and decreased effective renal plasma flow. This induces a reduction of intraglomerular pressure leading to stimulation of renin-angiotensin system to maintain the glomerular filtration rate. Other causes of renal dysfunction include electrolytes and acid-base disturbances, systemic inflammation, bile cast nephropathy, and intra-abdominal hypertension. Loss of renal reserve is usually the earliest manifestation of kidney dysfunction in cirrhotic patients. This makes the kidney supersensitive to any subsequent hemodynamic or metabolic abnormalities. Proper assessment of kidney function is one of the major challenges in cirrhotic patients. The use of serum creatinine and creatinine-based equations is inaccurate and can overestimate kidney function. Hepato-renal syndrome (HRS) is a life-threatening disorder. In the last decade, there was significant progress in understanding the mechanism of this mysterious disorder. In this article, we are focusing on different mechanisms of kidney dysfunction in cirrhotic patients and the major diagnostic and therapeutic challenges.

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“…Serum creatinine and creatinine clearance, calculated using equations such as the Cockcroft and Gault, Modification of Diet in Renal Disease-4 (MDRD-4), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and MDRD-6 equations, tend to overestimate the GFR of cirrhotic patients by approximately 23 ± 23 mL/min/1.73 m 2 [ 5 , 6 ], particularly in cases of advanced liver disease. The cystatin-C-based and combined cystatin C and creatinine equations show promise but have not been validated in cirrhotic patients.…”

Section: Introductionmentioning

confidence: 99%

Iohexol plasma and urinary concentrations in cirrhotic patients: A pilot study

Carrier¹,

Destère²,

Giguet³

et al. 2022

WJH

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BACKGROUND Renal failure is an independent prognostic factor for survival in patients with cirrhosis. Equations to calculate serum creatinine significantly overestimate the glomerular filtration rate (GFR). Plasma clearance of direct biomarkers has been used to improve the accuracy of evaluations of GFR in this population, but no study has simultaneously measured plasma and urinary clearance, which is the gold standard. AIM To study calculated plasma and urinary concentrations of iohexol, based on the kinetics of samples collected over 24 h from cirrhotic patients with three different grades of ascites. METHODS One dose of iohexol (5 mL) was injected intravenously and plasma concentrations were measured 11 times over 24 h in nine cirrhotic patients. The urinary concentration of iohexol was also measured, in urine collected at 4, 8, 12 and 24 h. RESULTS The plasma and urinary curves of iohexol were similar; however, incomplete urinary excretion was detected at 24 h. Within the estimated GFR limits of our population (> 30 and < 120 mL/min/1.73 m²), the median measured GFR (mGFR) was 63.7 mL/min/1.73 m² (range: 41.3–111.3 mL/min/1.73 m²), which was an accurate reflection of the actual GFR. Creatinine-based formulas for estimating GFR showed significant bias and imprecision, while the Brochner–Mortensen (BM) equation accurately estimated the mGFR ( r = 0.93). CONCLUSION Plasma clearance of iohexol seems useful for determining GFR regardless of the ascites grade. We will secondly devise a pharmacokinetics model requiring fewer samples andvalidate the BM equation.

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Beyond serum creatinine: which tools to evaluate renal function in cirrhotic patients?

Cited by 11 publications

References 53 publications

External Validation of a Pretransplant Biomarker Model (REVERSE) Predictive of Renal Recovery After Liver Transplantation

External Validation of a Pretransplant Biomarker Model (REVERSE) Predictive of Renal Recovery After Liver Transplantation

Renal Dysfunction in Patients with Liver Cirrhosis

Iohexol plasma and urinary concentrations in cirrhotic patients: A pilot study

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