Prevalence of renal dysfunction in patients with cirrhosis according to ADQI-IAC working party proposal

Abstract

Background/AimsA revised classification system for renal dysfunction in patients with cirrhosis was proposed by the Acute Dialysis Quality Initiative and the International Ascites Club Working Group in 2011. The aim of this study was to determine the prevalence of renal dysfunction according to the criteria in this proposal.MethodsThe medical records of cirrhotic patients who were admitted to Konkuk University Hospital between 2006 and 2010 were reviewed retrospectively. The data obtained at first admission were collected. Acute kidney injury (AKI) and chronic kidney disease (CKD) were defined using the proposed diagnostic criteria of kidney dysfunction in cirrhosis.ResultsSix hundred and forty-three patients were admitted, of whom 190 (29.5%), 273 (42.5%), and 180 (28.0%) were Child-Pugh class A, B, and C, respectively. Eighty-three patients (12.9%) were diagnosed with AKI, the most common cause for which was dehydration (30 patients). Three patients had hepatorenal syndrome type 1 and 26 patients had prerenal-type AKI caused by volume deficiency after variceal bleeding. In addition, 22 patients (3.4%) were diagnosed with CKD, 1 patient with hepatorenal syndrome type 2, and 3 patients (0.5%) with AKI on CKD.ConclusionsBoth AKI and CKD are common among hospitalized cirrhotic patients, and often occur simultaneously (16.8%). The most common type of renal dysfunction was AKI (12.9%). Diagnosis of type 2 hepatorenal syndrome remains difficult. A prospective cohort study is warranted to evaluate the clinical course in cirrhotic patients with renal dysfunction.

Renal dysfunctions in cirrhosis

“…Choi et al reported mortality rate as high as 66.7% in these patients. Mortality rates for patients with AKI and chronic kidney disease were 22.1% and 17.4% respectively in the same study (25). The reason of AKI in these patients can be structural or functional (24).…”

“…Oliguria criterion was not included in this classification because cirrhotic patients with refractory ascites can be oliguric even in the absence of AKI. The ADQI-IAC classification is summarized in table 4.Using ADQI-IAC criteria renal dysfunction prevalence in cirrhotic patients were reported to be 12,9% for AKI, 3,4% for CKD and 0,5% for AKI on CKD (25).…”

Impact of Chronic Kidney Disease on Outcomes in Cirrhosis

“…Almost a decade ago, CKD related to organic renal disease was regarded as uncommon among hospitalized patients with cirrhosis, occurring in approximately 1% of these patients . Over the course of 10 years, there have been several reports of increasing prevalence of CKD among hospitalized patients with cirrhosis, but the high prevalence of CKD seen in our cohort has not been reported. There may be several reasons for this observation.…”

“…Chronic kidney disease (CKD), especially organic CKD, in contrast, was once thought to be extremely uncommon among hospitalized patients with cirrhosis and was estimated to occur in 1% of these patients about a decade ago . However, recent reports suggest that organic CKD may be more common than previously thought, occurring in 3.4%‐13% of hospitalized patients with cirrhosis . With the recent change in the definition of CKD in cirrhosis from the persistent elevation of serum creatinine (SCr) to >1.5 mg/dL to one that requires the glomerular filtration rate (GFR) to be <60 mL/minute/1.73 m 2 for more than 3 months, CKD now encompasses both organic CKD due to structural renal damage as well as functional CKD that is brought on by the gradual deterioration of hemodynamics as the liver dysfunction worsens, ie, so‐called hepatorenal syndrome type 2 (HRS2) .…”

Spectrum of hepatitis B and renal involvement

“…Use of serum cystatin C‐based GFR may be more accurate and useful for early therapeutic intervention and possibly a favourable outcome . Although serum creatinine reflects renal function in patients with compensated cirrhosis fairly accurately, patients with decompensated cirrhosis often have low serum creatinine levels relative to their glomerular filtration rate(GFR)owing to reduced production of creatinine from creatine in the liver and significant muscle wasting . The use of creatinine clearance in cirrhosis to assess renal function is also unreliable because of the falsely low serum creatinine in these patients coupled with a relatively increased renal tubular creatinine secretion compared with filtered creatinine .…”