Urine Albumin-To-Creatinine Ratio is Associated with the Severity of Liver Disease, Renal Function and Survival in Patients with Decompensated Cirrhosis

Goulis, Ioannis; Ioannidou, Maria; Σουλαϊδόπουλος, Στέργιος; Chalevas, Parthenis; Akriviadis, Evangelos

doi:10.1016/s0168-8278(16)00289-0

Cited by 3 publications

(4 citation statements)

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“…Additionally, several studies have shown that renal dysfunction is associated with worse outcome in patients with decompensated cirrhosis . Along with eGFR, albuminuria is also associated with more severe liver disease in patients with decompensated cirrhosis . Thus, accurate and early identification of CKD is very important in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of chronic kidney disease in patients with chronic hepatitis B: A cross‐sectional survey

Liao

Lin

et al. 2017

Journal of Viral Hepatitis

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Renal safety is a major concern during long-term antiviral treatment for chronic hepatitis B (CHB). This study aimed to investigate the prevalence of chronic kidney disease (CKD) in patients with CHB that had been treated with antiviral therapy. This was a single-centre, cross-sectional study in a real-life cohort in which all patients received antiviral treatment. Serum creatinine-based equations from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) were used to estimate the glomerular filtration rate (GFR). CKD was defined as an eGFR <60 mL/min/1.73 m² or a urinary albumin to creatinine ratio ≥ 3 mg/mmol (defined as albuminuria). Univariate and multivariate analyses were conducted to determine the risk factors of CKD. A total of 1985 patients were included in the analysis from February 2015 to December 2015. The mean age and median duration of antiviral treatment was 42.20 years and 17.05 months, respectively. The overall prevalence of CKD was 7.9% (157/1985), with 44 patients experiencing decreased renal function (eGFR less than 60 mL/min/1.73 m²) and 129 patients with albuminuria. Patients with cirrhosis had a higher prevalence of a decreased GFR (4.3% vs 1.6%, P<.001) and albuminuria (11.1% vs 5.2%, P<.001) than those without cirrhosis. In the multivariate analysis, hypertension (Odds Ratio [OR] 4.564, P<.001), diabetes mellitus (OR 2.688, P<.001) and cirrhosis (OR 1.918, P<.001) were independent factors associated with the presence of CKD. CKD was a clinically significant comorbidity in patients with CHB. Special attention should be paid to cirrhotic patients and patients with the metabolic syndrome.

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Section: Discussionmentioning

confidence: 99%

Prevalence of chronic kidney disease in patients with chronic hepatitis B: A cross‐sectional survey

Liao

Lin

et al. 2017

Journal of Viral Hepatitis

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“…A urine albumin/creatinine ratio ≥30 mg/g is associated with more severe liver disease, lower GFR, and worse liver transplantation-free survival in patients with decompensated cirrhosis [9]. Indeed, it was reported that albuminuria is associated with AKI in cirrhotic Indeed, it was shown that patients with HRS-AKI have marked systemic inflammation with an altered cytokine profile compared to patients with decompensated cirrhosis without AKI.…”

Section: Discussionmentioning

confidence: 99%

“…Alternative urinary markers (e.g., cystatin C, neutrophil gelatinase-associated lipocalin (NGAL) and urinary IL-18) are not widely available [8]. A urine albumin creatinine ratio (UACR) ≥30 mg/g is associated with more severe liver disease and a lower glomerular filtration rate (GFR) in patients with decompensated cirrhosis [9]. It was reported that albuminuria predicted AKI in liver cirrhosis [7] and mortality in HE [10].…”

Section: Introductionmentioning

confidence: 99%

The urine albumin creatinine ratio is one of the predictors of acute kidney injury in hepatitis C-related cirrhotic hepatic encephalopathy

Shahbah

Osman

Mostafa

et al. 2022

Egypt Liver Journal

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Background/objective Hepatic encephalopathy (HE) is a main manifestation of acute decompensation in liver cirrhosis. Recently, systemic inflammation was proposed as a key mechanism in the development of acute kidney injury (AKI) in cirrhotic patients. The urine albumin creatinine ratio (UACR) is considered a marker of systemic inflammation in a variety of clinical settings. Here, we aimed to evaluate the role of the urine albumin creatinine ratio in the early prediction of AKI in HE. Patients and methods Sixty-seven consecutive patients presented with cirrhotic HE, and 59 age- and sex-matched cirrhotic patients with no history of HE served as controls. HE was defined and graded by the West Haven criteria. The severity of liver cirrhosis was evaluated by the Child-Turcotte-Pugh (CTP) score, and model for end-stage liver disease (MELD) score. The incidence of AKI that developed during hospital admission and the in-hospital mortality rate was estimated among HE patients. In addition, predictors of AKI were analyzed. Results The mean age of HE patients was 58.09±12.26 years; 36 (53.7%) were males, and 31 (46.3%) were females. Among HE patients, 16 (23.9%) developed AKI during hospital admission. The in-hospital mortality rate among HE patients was 22 (32.8%), the in-hospital mortality among HE-AKI patients was 81.3% (n=13/16), and UACR levels > 91.5 mg/g identified HE-AKI with 81.25% sensitivity (AUC = 0.85, P ≤ 0.001). Conclusions Patients with cirrhotic HE are at high risk of AKI. HE-AKI patients had a high rate of in-hospital mortality. Estimation of UACR at hospital admission is suggested for the early detection of patients with HE-AKI.

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“…14 It is worth mentioning that albuminuria, which is part of the CKD definition, has been shown to be a sensitive index of kidney damage in patients with diabetes mellitus, arterial hypertension or glomerular nephritis. 15 In cirrhosis, urine albumin-to-creatinine ratio (ACR, a simple tool to assess albuminuria in a random urine sample) >30 mg/g was associated with more severe liver disease, lower glomerular filtration rate (GFR) and worse liver transplant-free survival in decompensated patients 16 ; furthermore, in a cohort of hospitalized cirrhotic patients albuminuria was found to be significantly higher in patients with AKI progression and death than in those with progression alone or no progression. 17 Whether acute or chronic, renal dysfunction severely impacts the prognosis of cirrhotic patients.…”

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confidence: 99%

Assessment of glomerular filtration rate in patients with cirrhosis: Available tools and perspectives

Campion

Rizzi

Bonetto

et al. 2022

Liver International

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Renal dysfunction is frequent in cirrhotic patients and is associated with a worse prognosis. 1 Cirrhotic patients share with the general population common aetiologies of kidney dysfunction, including pre-renal, intrinsic and post-renal causes of acute kidney injury (AKI), as well as all the known causes of chronic kidney disease (CKD), such as diabetic or hypertensive nephropathy. 2 Additionally, they may suffer from a specific kind of renal dysfunction, hepatorenal syndrome (HRS). 3,4 Among patients hospitalized for acutely decompensated cirrhosis, about 50% present AKI (definition in Table 1) 5 ; in one-third of them, renal impairment occurs after admission. 6,7 Episodes of AKI can also occur during the follow-up in up to 50% of outpatients with decompensated cirrhosis. 8 As regards CKD (definition in Table 2), 9 this is a highly common comorbidity among patients with liver diseases, and particularly among those with decompensated cirrhosis, in whom the prevalence of CKD stage 3 or higher is reported to range from 20% to 40%. [10][11][12][13]

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Urine Albumin-To-Creatinine Ratio is Associated with the Severity of Liver Disease, Renal Function and Survival in Patients with Decompensated Cirrhosis

Cited by 3 publications

References 0 publications

Prevalence of chronic kidney disease in patients with chronic hepatitis B: A cross‐sectional survey

Prevalence of chronic kidney disease in patients with chronic hepatitis B: A cross‐sectional survey

The urine albumin creatinine ratio is one of the predictors of acute kidney injury in hepatitis C-related cirrhotic hepatic encephalopathy

Assessment of glomerular filtration rate in patients with cirrhosis: Available tools and perspectives

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