Effect of coexisting diabetes mellitus and chronic kidney disease on mortality of cirrhotic patients with esophageal variceal bleeding

Abstract

BackgroundEsophageal variceal bleeding (EVB) is a serious and common complication of cirrhosis. Diabetes mellitus (DM) and chronic kidney disease (CKD) increase mortality in patients with cirrhosis. However, whether coexisting DM and CKD increase mortality in cirrhotic patients with EVB remains unclear.MethodsWe enrolled cirrhotic patients hospitalized with the first presentation of EVB from 2005 through 2010 using Longitudinal Health Insurance Database 2005. The hazard ratios (HRs) of 42-day and one-year EVB mortality were calculated using Cox regression model.ResultsWe identified 888 patients hospitalized with the first presentation of EVB. Among the cirrhotic patients with EVB, all-cause mortality at 42-day and one-year were 21.3 and 45.0 %, respectively. The respective HRs for the 42-day and one-year mortality were 1.80 (95 % confidence interval [CI], 1.10–2.97) and 1.52 (95 % CI, 1.06–2.17) for patients with CKD and 0.79 (95 % CI, 0.57–1.10) and 0.88 (95 % CI, 0.71–1.09) for patients with DM. Specifically, coexisting CKD and DM increased the 42-day and one-year mortality with respective HRs of 1.99 (95%CI, 1.03–3.84) and 1.84 (95%CI, 1.14–2.98) compared with those without CKD and DM. The HRs for 42-day and 1-year mortality in female patients with DM and CKD were 4.03 (95%CI, 1.40–11.59) and 2.84 (95%CI, 1.31–6.14) respectively, and were 2.93 (95%CI, 1.14–7.57) and 2.42 (95%CI, 1.28–4.57) in male patients with DM and CKD.ConclusionWe identified that coexisting DM and CKD increased risk of mortality at 42 days and 1 year following EVB.

Impact of Chronic Kidney Disease on Outcomes in Cirrhosis

“…Although not specifically assessed in this study, patients with cirrhosis with CKD are also at risk for other complications, such as failure to control variceal bleeding, related to uremic platelet dysfunction . Thus, the development of CKD in cirrhosis significantly adds to their morbidity and mortality …”

“…(32) Thus, the development of CKD in cirrhosis significantly adds to their morbidity and mortality. (33,34) Once admitted, the prognosis of the CKD+ patients becomes significantly worse when compared with the CKD-patients. Regardless of the reason for hospitalization, CKD+ patients were significantly more likely to develop superimposed AKI, with less likelihood to recover from the AKI episodes, hence being more likely to require dialysis.…”

Acute kidney injury predicts mortality in cirrhotic patients with gastric variceal bleeding

“…[5][6][7][8] Regarding renal function impairment, acute renal failure (ARF) is more relevant than chronic kidney disease (CKD) in predicting mortality. [9][10][11] Acute renal failure occurs in approximately 20% of hospitalized cirrhotic patients. 12 Traditionally, ARF in cirrhosis has been defined as a percentage increase in serum creatinine (sCr) ≥ 50% to a final value ≥ 1.5 mg/dL (conventional criteria).…”

“…Mortality after acute variceal bleeding has been shown to be predicted by some risk factors, including the Child‐Pugh score or its components, the model of end‐stage liver disease (MELD) score, hypovolemic shock, hepatocellular carcinoma (HCC), active bleeding at endoscopy, hepatic venous pressure gradient, and renal function impairment . Regarding renal function impairment, acute renal failure (ARF) is more relevant than chronic kidney disease (CKD) in predicting mortality …”