Cystatin C predicts acute kidney injury and mortality in cirrhotics: A prospective cohort study

Maiwall, Rakhi; Kumar, Ashwani; Bhardwaj, Ankit; Kumar, Guresh; Bhadoria, Ajeet Singh; Sarin, Shiv Kumar

doi:10.1111/liv.13600

Cited by 64 publications

(69 citation statements)

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“…Studies in patients without cirrhosis have well documented that, even if patients recover from an AKI episode and have normal sCr and GFR, considerable loss of nephrons and renal functional reserve occurs, predisposing these patients not only to future episodes of AKI, but also increased susceptibility to the precipitant minor insults, causing severe damage to the kidneys . Consistent with these findings, we have reported that AKI itself predisposes a patient with cirrhosis to future episodes of AKI . All attempts should therefore be made to prevent repeated episodes of AKI because these are detrimental for the kidneys and may also necessitate a simultaneous liver‐kidney transplant if this remains unabated by leading to CKD.…”

Section: Discussionsupporting

confidence: 83%

“…(5)(6)(7) Consistent with these findings, we have reported that AKI itself predisposes a patient with cirrhosis to future episodes of AKI. (10) All attempts should therefore be made to prevent repeated episodes of AKI because these are detrimental for the kidneys and may also necessitate a simultaneous liver-kidney transplant if this remains unabated by leading to CKD. It can be argued that eGFR is a derived value and may not be appropriate for understanding the functional variations in the kidney after AKI.…”

Section: Discussionmentioning

confidence: 99%

“…We have recently reported on the utility of cystatin C (CysC) as a marker of renal reserve and risk of future AKI in a large cohort of 531 patients with cirrhosis followed for a year. However, whether CysC can also predict development of CKD needs to be explored …”

mentioning

confidence: 99%

“…However, whether CysC can also predict development of CKD needs to be explored. (10,11) We therefore aimed to prospectively study the incidence and risk factors for development of CKD in patients with cirrhosis. We evaluated the role of CysC as a potential biomarker and AKI as a risk factor for CKD development in these patients.…”

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confidence: 99%

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Incidence, Risk Factors, and Outcomes of Transition of Acute Kidney Injury to Chronic Kidney Disease in Cirrhosis: A Prospective Cohort Study

et al. 2019

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Transition to chronic kidney disease (CKD) after an episode of acute kidney injury (AKI) is known in patients without cirrhosis. We studied the incidence and risk factors for development of CKD in patients with cirrhosis. Competing risk analysis was performed to identify risk factors for CKD development. Of 818 patients with cirrhosis (age, 50.4 ± 11.8 years; 84% males; Model for End‐Stage Liver Disease [MELD], 19.9 ± 9.9), 36% had AKI at enrollment, 27% had previous AKI, and 61% developed new episodes of AKI during the follow‐up period. CKD developed in 269 (33%) patients. Serum cystatin C (CysC; subdistribution hazard ratio [SHR], 1.58; 1.07‐2.33), episodes of previous AKI (SHR, 1.26; 1.02‐1.56), and AKI stage at enrollment (no AKI [SHR, 1] vs. stage 1 [SHR, 3.28; 1.30‐8.25] vs. stage 2 [SHR, 4.33; 1.76‐10.66] vs. stage 3 [SHR, 4.5; 1.59‐12.73]) were identified as baseline risk factors for CKD development. On time‐varying competing risk analysis, MELD (SHR, 1.01; 1.00‐1.03), number of AKI episodes (SHR, 1.25; 1.15‐1.37), and CysC (SHR, 1.38; 1.01‐1.89) predicted CKD development. Development of CKD was associated with higher risk of death. Reduction in glomerular filtration rate (GFR) not meeting CKD criteria was observed in 66% of patients with cirrhosis, more so in those with previous AKI episodes and a high CysC level and MELD score. Renal histology, available in 55 patients, showed tubulointerstitial injury in 86%, cholemic nephrosis in 29%, and glomerular changes in 38%. Conclusion: Almost two‐thirds of patients with cirrhosis develop episodes of AKI and reduction in GFR; one‐third progress to CKD, resulting in adverse outcomes. Higher MELD and CysC levels and number of AKI episodes predict development of CKD in patients with cirrhosis.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Incidence, Risk Factors, and Outcomes of Transition of Acute Kidney Injury to Chronic Kidney Disease in Cirrhosis: A Prospective Cohort Study

et al. 2019

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“…To date, the following biomarkers have been validated for early detection of AKI: sCysC, serum and urine neutrophil gelatinase-associated lipocalin [23,24], kidney injury molecule 1 [25], urinary insulin-like growth factor-binding protein 7 [26], and urinary interleukin 18 [27]. Among these, sCysC is reportedly an early biomarker for diagnosing AKI in patients receiving cardiac surgery [22,28], with liver cirrhosis [29] or sepsis [24]. However, little is known about an association between sCysC and the risk of AKI after stroke based on KDIGO-AKI criteria in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk factors, and Biomarkers Predicting Ischemic or Hemorrhagic Stroke Associated Acute Kidney Injury and Outcome: A Retrospective Study in a General Intensive Care Unit

Jiang

Xiang

et al. 2019

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Objective: We investigated the epidemiology, risk factors, and predictive parameters for ischemic or hemorrhagic stroke-associated acute kidney injury (AKI) and mortality in a general intensive care unit (ICU) in China. Methods: During 5 years, 479 stroke patients were screened, and 381 were enrolled. AKI was diagnosed within 7 days after ICU admission, based on the Kidney Disease Improving Global Outcomes criteria. Risk factors of AKI were assessed by Logistic regression analyses, and the predictive biomarkers for AKI were determined using receiver operating characteristic (ROC) curves. Also examined were factors influencing 28-day mortality, using Cox regression analyses and Kaplan-Meier curves. Results: Among all, 115 (30.18%) patients developed AKI. Multivariate regression analyses revealed that the following features at ICU admission significantly increased the risk of developing AKI: an increased National Institutes of Health Stroke Scale score (OR 1.136, p < 0.001) and Acute Physiology and Chronic Health Evaluation II score (OR 1.107, p = 0.042); hypertension (OR 2.346, p = 0.008); use of loop diuretics (OR 1.961, p = 0.032); and higher serum cystatin C (sCysC; OR 8.156, p = 0.001). The area under the ROC curves for predicting AKI using sCysC was 0.772, slightly better than that of other biomarkers. The sCysC ≥0.93 mg/L (hazard ratio 1.844, p = 0.004) significantly predicted 28-day mortality. Conclusions: Among stroke patients in ICU, we identified significant risk factors of stroke-associated AKI. Serum CysC level at ICU admission was an important biomarker for predicting AKI and 28-day mortality.

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Degree of Portal and Systemic Hemodynamic Alterations Predict Recurrent AKI and Chronic Kidney Disease in Patients With Cirrhosis

Maiwall¹,

Pasupuleti

Jain³

et al. 2021

Hepatology Communications

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The relevance of hemodynamic derangements on the incidence of recurrent acute kidney injury (AKI) and chronic kidney disease (CKD) in patients with cirrhosis is largely unknown. Consecutive patients with cirrhosis with a complete record of baseline hemodynamics were followed for identifying risk factors for the development of recurrent AKI and CKD by using negative binomial regression and competing risk analysis, respectively. Consecutive patients with cirrhosis (n = 2013, age 50.1 ± 11.8 years, 80% male, Child A:B:C percentage 13.7:52.9:33.4, and mean Child-Turcotte-Pugh score 8.6 ± 1.8) were enrolled, 893 (44.3%) of whom received beta-blockers, with 44.2% responders. Prior AKI was noted in 12.4% at enrollment. At a median follow-up of 379 (interquartile range: 68-869) days, AKI developed at a rate of 0.37 episodes per person-year, and 26% patients developed CKD. A lower mean number of AKI episodes (0.05 ± 0.25 vs. 0.42 ± 0.868; P < 0.001), CKD (subdistribution hazard ratio 0.74 [0.54-1.02]), and mortality (hazard ratio 0.21 [0.06-0.73]) were observed in beta-blocker responders. Albuminuria was an independent risk factor for recurrent AKI, CKD, and mortality (P < 0.05). Lower systemic vascular resistance index predicted hemodynamic response (odds ratio 2.04 [1.29-3.22]), cumulative AKI episodes (ratio of means 0.10 [0.08-0.14]), and development of CKD (subdistribution hazard ratio 0.70 [0.58-0.83]). Higher hepatic venous pressure gradient (≥17 mm Hg) predicted AKI episodes (ratio of means 1.76 [1.32-2.35]) but not CKD. Conclusion: High portal pressure and severe vasodilatation predispose patients with cirrhosis to repeated AKI episodes and development of CKD. Response to beta-blockers and therapies targeting the vasodilatory state could prevent frequent AKI and the risk of CKD development. Albuminuria could serve as an early marker of renal dysfunction in patients with cirrhosis. (Hepatology Communications 2020;0:1-16). T he prognostic significance of acute kidney injury (AKI) is well-known in patients with cirrhosis. AKI is seen in almost 20% of hospitalized patients with cirrhosis and associated with significant morbidity and mortality. (1) Patients with cirrhosis are predisposed to develop multiple AKI episodes. It has been shown that AKI is a predisposing factor for subsequent AKI and in almost one-third of these patients' progress to chronic kidney disease (CKD). (2) This is governed

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Cystatin C predicts acute kidney injury and mortality in cirrhotics: A prospective cohort study

Abstract: An episode of AKI itself predisposes to subsequent attacks of AKI in cirrhotics. Scores incorporating CysC can accurately predict the development of AKI and mortality in these patients.

Cited by 64 publications

References 18 publications

Incidence, Risk Factors, and Outcomes of Transition of Acute Kidney Injury to Chronic Kidney Disease in Cirrhosis: A Prospective Cohort Study

Incidence, Risk Factors, and Outcomes of Transition of Acute Kidney Injury to Chronic Kidney Disease in Cirrhosis: A Prospective Cohort Study

Incidence, Risk factors, and Biomarkers Predicting Ischemic or Hemorrhagic Stroke Associated Acute Kidney Injury and Outcome: A Retrospective Study in a General Intensive Care Unit

Degree of Portal and Systemic Hemodynamic Alterations Predict Recurrent AKI and Chronic Kidney Disease in Patients With Cirrhosis

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