Renal Hemodynamics in Patients with Cirrhosis: Relationship with Ascites and Liver Failure

Abstract

In patients with cirrhosis and ascites decreased renal blood flow might be related to the severity of liver disease but the relationship beween the severity of cirrhosis and renal perfusion has not yet been established. Thus we measured renal, systemic and splanchnic hemodynamics in 63 patients with ascites and in 28 without ascites. When compared to patients without ascites, patients with ascites had lower renal blood flow (1,170 ± 100 vs. 935 ± 55 ml/min/1.73 m²; mean ± SEM, p < 0.05) and renal perfusion pressure (78 ± 2 vs. 72 ± 1 mm Hg, p < 0.05 and higher inferior vena cava pressure (6.5 ± 0.7 vs. 10.7 ± 0.7 mm Hg, p < 0.05). Patients with ascites had significantly higher serum bilirubin concentrations, hepatic venous pressure gradient and lower serum albumin concentrations, indocyanine green (ICG) extraction than patients without ascites. Renal vascular resistance, glomerular filtration rate, mean arterial pressure, cardiac index and systemic vascular resistance were not significantly different between the two groups. By multiple regression analysis no significant correlation was found between liver tests (i.e., prothrombin time, serum bilirubin and albumin concentrations, ICG extraction), hepatic venous pressure gradient, cardiac index and systemic vascular resistance on the one hand and renal blood flow on the other. No significant correlation was found between glomerular filtration rate and liver tests. In conclusion, in patients with cirrhosis and ascites, renal hypoperfusion is not related to the severity of liver disease.

Incidence and risk factors for radiocontrast-induced nephropathy in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization

“…These results are consistent with several other studies in that the severity of liver function was correlated with the occurrence of ARF [4,11,12,[19][20][21]; however, previous studies were designed to show the occurrence of ARF, not RCIN. Therefore, the mechanisms by which radiocontrast dye affects renal function in patients with HCC undergoing TACE are unknown.…”

Transjugular Intrahepatic Portosystemic Stent-Shunt

“…This study has failed to demonstrate any relationship between the change in UNa and CrCI and Pugh score. This finding is supported by Moreau et.al. (1993) who found no correlation between renal blood flow and the severity of liver disease as assessed by antipyrine clearance.…”

Acute renal failure after transarterial chemoembolization for hepatocellular carcinoma: a retrospective study of the incidence, risk factors, clinical course and long‐term outcome

“…This result indicates that the risk of ARF from TACE is increased in patients with advanced liver cirrhosis and is in agreement with previous studies suggesting that the occurrence of renal dysfunction is correlated with the severity of liver cirrhosis. 19,[32][33][34] A very novel finding in this study is that DM and Child-Pugh class B were closely linked with the occurrence of prolonged ARF, with an increased risk ratio of up to 5.2 and 4.3 respectively ( Table 2). It is well accepted that patients with diabetic nephropathy are at a higher risk of developing acute and chronic renal insufficiency.…”