Estimated Glomerular Filtration Rate (eGFR) Values as Predictor of Renal Insufficiency in Advanced Stages of Liver Diseases with Different Etiology

Abstract

Background:Various complications occur in patients with advanced stages of liver diseases. Renal dysfunction, a parameter included in the MELD score, is the most important prognostic factor. There is a strong need in clinical practice to estimate the GFR in this patients.Objectives:The aim of our study was to detect differences in renal function among patients with different stages of chronic liver diseases caused by HBV and HCV, also to determine the impact of viral etiology and gender on the values of eGFR and renal function.Patients and Methods:This was an observational cross-sectional study performed on patients with HBV and HCV chronic hepatitis, cirrhosis and HCC caused by these viruses hospitalized during period 2009–2014 in the Clinic of Gastroenterohepatology, Clinical Center University of Sarajevo. The estimated GFR (eGFR) was evaluated by the MDRD4 method. For the processing of data SPSS 21.0 statistical software was used. Statistical methods used in this study where: analysis of variance test (ANOVA test), Student’s t-test for independent samples and Pearson coefficient of correlation. The level of significance was p <0.05.Results:Among this three groups of patients there was a statistically significant difference in eGFR (F= 18.79, p<0.05), i.e. increase of degree of liver damage was related with increase of renal impairment, as reflected by a significant reduction in estimated glomerular filtration rate. Gender had no significant effect on eGFR and renal function (p>0.05), except in group of patients with HCC (p<0.05). Etiology had no significant effect on eGFR and renal (p>0.05). There was statistically significant inverse correlation between glomerular filtration rate and liver enzymes AST (-.184) and GGT (-.181).Conclusions:By calculation of GFR, we determined the existence of a significant reduction of kidney function through progression of liver damage from HBV and HCV chronic hepatitis, liver cirrhosis to HCC caused by these viruses, which drawing attention to the importance of the assessment of renal function in patients with this liver pathologies. Gender and etiology had no significant effect on eGFR and impairment of renal function. Given the statistically significant inverse correlation between eGFR and AST and GGT this liver enzymes may have important role as marker for both renal and hepatic injury.

Role of Cystatin C and glomerular filtration rate in diagnosis of kidney impairment in hepatic cirrhosis patients

“…Our results showed serum CysC and eGFR CysC were superior to SCr and eGFR SCr in the diagnostic performance of kidney impairment in these patients. A recent study also reveals that serum CysC based eGFR may more accurately reflect the GFR in hepatic cirrhosis patients [ 28 ] and thus can be used to evaluate the kidney function [ 29 , 30 ] and prognosis. [ 31 ] In addition, our findings also showed that eGFR CysC had the highest performance in the diagnosis of secondary kidney impairment and its optimal cut-off value was 63.4 mL/min/1.73 m 2 (Table 2 ).…”

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

“…Renal dysfunction is one such complication that is characterized by impaired natriuresis, decreased free water clearance, and decreased GFR. [3] In the initial stages of cirrhosis, to maintain effective circulatory volume, cardiac output raises to balance the decrease in systemic vascular resistance. But with disease progression, this compensation becomes ineffective.…”

“…[15] Optimal management of renal dysfunction in cirrhosis is extremely important as it frequently complicates the clinical course of advanced liver disease and is invariably associated with poor clinical outcomes. [3] Gomes et al . showed in a study that serum creatinine in MELD score had no impact as a prognostic tool for acute kidney injury (AKI) in liver transplant patients, despite its high impact on MELD calculation.…”

“…[4] The incidence of renal dysfunction in cirrhosis is approximately 8% with ascites but the prevalence increases with advancement of the disease. [3]…”

Reduction effect of the quantity of radiation exposure and contrast media by image support system in transarterial chemoembolization for the treatment of hepatocellular carcinoma

“…The radiation exposure for both the patient and the operator is significant. Furthermore, the mean age of patients affected by HCC has shifted toward an older age each year and the numbers of HCC patients with coexisting chronic kidney disease, a condition aggravated by chronic liver disease, increase each year. If clinicians can reduce contrast media use by targeting a feeding artery for treatment and at the same time reduce fluoroscopy time, patients will benefit.…”