Correlation between MELD and UNa/K ratio in predicting renal dysfunction in cirrhotic patients

Abstract

BackgroundRenal dysfunction is one of the dreaded complications of cirrhosis. MELD is a validated chronic liver disease (CLD) severity scoring system. Urinary (U) Na/K ratio closely correlates with renal dysfunction in terms of low GFR in cirrhotic patients.Patients and MethodsAll consecutive patients with decompensated cirrhosis between the age of 18 to 70 years, of either gender, presenting in the outpatients’ department of Sindh Institute of Urology and Transplantation, Karachi, from June 2015 to June 2017 were included. The MELD score was calculated and the UNa/K ratio less than 1 was taken as surrogate marker of renal dysfunction. Statistical analysis was performed by SPSS (version 20.0).ResultsA total of 71 patients were enrolled. The mean age was 43.79 years and majority were male (67.6%). The most common cause of liver cirrhosis was HCV, found in 42 (59.2%) patients. The mean CTP score was 10.48 ± 2.069 (range: 6–14) with majority of the patients following in class C, that is, 48 (67.6%). Mean MELD score was 21.75 ± 8.96 (range: 8–43). In 57 patients (80.3%), MELD score was > 15.The mean serum creatinine and mean serum sodium were 1.5 ± 1.1 mg/dl (range: 0.37–5.3) and 133.79 ± 6.9 mmol/L (range: 112–152), respectively. Mean urinary sodium and urinary potassium were 38.60 ± 46.64 mmol/L (range: 5–181) and 38.15 ± 23.9 mmol/L (range: 4.3–112), respectively. In majority of study population, UNa/K ratio was below 1, that is, in 52 patients (73.2%). Statistically significant correlation was documented between MELD score and UNa/K ratio (ɤ = 0.34, P = 0.004).ConclusionThe inverse correlation between MELD scores and UNa/K ratio indicates that patients with CLD and higher MELD scores might have renal dysfunction. This finding however should be corroborated by large scale studies.

Spot Urine Sodium and Potassium Ratio as a Predictor of Acute Kidney Injury and Survival in Decompensated Cirrhosis

“…Our study found that reduced sodium excretion, either as spot urine Na/K ratio or FENa, was related to more severe liver disease, i.e., high MELD-Na score or high CTP score. Similarly, Iqbal J et al found that a high MELD score was associated with low urine Na/K ratio [15] . da Silva OM et al found that poor sodium excretion group presented higher MELD score [16] .…”

Síndrome Hepatorrenal: Revisión De La Literatura

“…La puntuación MELD/Na es un sistema de puntuación para acceder a la gravedad de la enfermedad hepática crónica utilizando valores como bilirrubina sérica, creatinina sérica y el índice internacional normalizado de tiempo de protrombina y sodio, para predecir la supervivencia. También es un puntaje utilizado para determinar la necesidad para trasplante hepático en los pacientes cirróticos, MELD > 15 puntos se considera paciente tributario a evaluación para trasplante hepático [47,48].…”