Royal Free Hospital‐estimated glomerular filtration rate for prognostic stratification of first acute kidney injury in cirrhosis
Background & Aims Renal function is a major determinant of prognosis in patients with cirrhosis. Current guidelines only contemplate serum creatinine (sCr) to assess kidney injury. However, there are formulas to estimate glomerular filtration rate (eGFR) which better measure renal function in pa...
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| Veröffentlicht in: | Liver international 2021-04, Vol.41 (4), p.819-827 |
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| creator | Rodrigues, Susana G. Abraldes, Juan G. Tsochatzis, Emmanouil Bosch, Jaime Berzigotti, Annalisa |
| description | Background & Aims
Renal function is a major determinant of prognosis in patients with cirrhosis. Current guidelines only contemplate serum creatinine (sCr) to assess kidney injury. However, there are formulas to estimate glomerular filtration rate (eGFR) which better measure renal function in patients listed for liver transplantation. There is no data available on whether these formulas predict prognosis in patients with acute kidney injury (AKI).
Methods
In 143 patients presenting with a first episode of AKI, we compared the prognostic value of renal function estimated using sCr or eGFR assessed with Modification of Diet in Renal Disease (MDRD‐6), chronic kidney disease epidemiology (CKD‐EPI) and Royal Free Hospital (RFH) for renal replacement therapy (RRT) within 30 days of AKI, and 30‐ and 90‐day transplant‐free survival.
Results
eGFR was calculated on values obtained before and at admission, at presentation of AKI (D0) and 48 hours after AKI (D2).15% of patients (more commonly in alcohol + metabolic etiology; P = .049 vs other) required RRT. Transplant‐free survival at 30‐and 90‐day were 77% and 63%. Among sCr, MDRD‐6, CKD‐EPI and RFH‐eGFR, the latter predicted best RRT (HR 0.937 95% CI 0.893‐0.982, P = .007), 30‐d (HR 0.936 95% CI 0.901‐0.972, P = .001) and 90‐d (HR 0.934 95% CI 0.908‐0.972, P |
| doi_str_mv | 10.1111/liv.14765 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2470025163</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2470025163</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3885-4a104884c5852914aa3f5a3c87242e3c70d8cbee1ec40e0823bc14d81937dc423</originalsourceid><addsrcrecordid>eNp1kc1OGzEUha2qqElpF30BZKkbukjwL-MsEYKCFAkJQbeW47lDnTrjYM-AskN9gj5jn4QLA1kg4c2x5M9H595DyDfOphzPQQx3U66qQ_2BjFHNRArJP27vQo7I51KWjPHZTPNPZCSl5EorOSZ_L9PGRXqaAehZKuvQufj_4R-ULqxcBzW9iWkFuY8u0ybELrsupJaiAG1SpuucbtqEtKfl-bEJfkBSgx9y6ajzPcJ_Qt3ChoZ22ecnoT7k_DuVUL6QncbFAl9fdJdcn55cHZ9N5hc_z4-P5hMvjdET5ThTxiivjRYzrpyTjXbSm0ooAdJXrDZ-AcDBKwbMCLnwXNWGz2RVeyXkLtkffDHzbY8T2lUoHmJ0LaS-WKEqxoTmhxLR72_QZepzi-ms0AwXKjABUj8GyudUSobGrjNuLW8sZ_apGIvF2OdikN17cewXK6i35GsTCBwMwH2IsHnfyc7Pfw2Wj7Domks</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2502232291</pqid></control><display><type>article</type><title>Royal Free Hospital‐estimated glomerular filtration rate for prognostic stratification of first acute kidney injury in cirrhosis</title><source>Wiley Online Library All Journals</source><creator>Rodrigues, Susana G. ; Abraldes, Juan G. ; Tsochatzis, Emmanouil ; Bosch, Jaime ; Berzigotti, Annalisa</creator><creatorcontrib>Rodrigues, Susana G. ; Abraldes, Juan G. ; Tsochatzis, Emmanouil ; Bosch, Jaime ; Berzigotti, Annalisa</creatorcontrib><description>Background & Aims
Renal function is a major determinant of prognosis in patients with cirrhosis. Current guidelines only contemplate serum creatinine (sCr) to assess kidney injury. However, there are formulas to estimate glomerular filtration rate (eGFR) which better measure renal function in patients listed for liver transplantation. There is no data available on whether these formulas predict prognosis in patients with acute kidney injury (AKI).
Methods
In 143 patients presenting with a first episode of AKI, we compared the prognostic value of renal function estimated using sCr or eGFR assessed with Modification of Diet in Renal Disease (MDRD‐6), chronic kidney disease epidemiology (CKD‐EPI) and Royal Free Hospital (RFH) for renal replacement therapy (RRT) within 30 days of AKI, and 30‐ and 90‐day transplant‐free survival.
Results
eGFR was calculated on values obtained before and at admission, at presentation of AKI (D0) and 48 hours after AKI (D2).15% of patients (more commonly in alcohol + metabolic etiology; P = .049 vs other) required RRT. Transplant‐free survival at 30‐and 90‐day were 77% and 63%. Among sCr, MDRD‐6, CKD‐EPI and RFH‐eGFR, the latter predicted best RRT (HR 0.937 95% CI 0.893‐0.982, P = .007), 30‐d (HR 0.936 95% CI 0.901‐0.972, P = .001) and 90‐d (HR 0.934 95% CI 0.908‐0.972, P < .001) mortality/OLT.
Conclusions
Renal function estimated using the RFH‐eGFR calculated at D2 after AKI diagnosis is a strong predictor of RRT and of 30‐d and 90‐d transplant‐free survival. Results suggest that in cirrhosis, RFH‐eGFR may be a better indicator of prognosis in AKI than sCr.</description><identifier>ISSN: 1478-3223</identifier><identifier>EISSN: 1478-3231</identifier><identifier>DOI: 10.1111/liv.14765</identifier><identifier>PMID: 33314543</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>advanced chronic liver disease ; chronic kidney disease ; Cirrhosis ; Creatinine ; Epidemiology ; Epidermal growth factor receptors ; Etiology ; Glomerular filtration rate ; hepatorenal syndrome ; Injuries ; Kidney diseases ; Kidney transplantation ; Kidneys ; Liver cirrhosis ; Liver transplantation ; Mathematical analysis ; Medical prognosis ; Prognosis ; Renal function ; Survival ; Transplantation ; Transplants & implants</subject><ispartof>Liver international, 2021-04, Vol.41 (4), p.819-827</ispartof><rights>2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><rights>2021 John Wiley & Sons A/S</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3885-4a104884c5852914aa3f5a3c87242e3c70d8cbee1ec40e0823bc14d81937dc423</citedby><cites>FETCH-LOGICAL-c3885-4a104884c5852914aa3f5a3c87242e3c70d8cbee1ec40e0823bc14d81937dc423</cites><orcidid>0000-0001-5069-2461 ; 0000-0003-3421-937X ; 0000-0003-4562-9016</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fliv.14765$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fliv.14765$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33314543$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rodrigues, Susana G.</creatorcontrib><creatorcontrib>Abraldes, Juan G.</creatorcontrib><creatorcontrib>Tsochatzis, Emmanouil</creatorcontrib><creatorcontrib>Bosch, Jaime</creatorcontrib><creatorcontrib>Berzigotti, Annalisa</creatorcontrib><title>Royal Free Hospital‐estimated glomerular filtration rate for prognostic stratification of first acute kidney injury in cirrhosis</title><title>Liver international</title><addtitle>Liver Int</addtitle><description>Background & Aims
Renal function is a major determinant of prognosis in patients with cirrhosis. Current guidelines only contemplate serum creatinine (sCr) to assess kidney injury. However, there are formulas to estimate glomerular filtration rate (eGFR) which better measure renal function in patients listed for liver transplantation. There is no data available on whether these formulas predict prognosis in patients with acute kidney injury (AKI).
Methods
In 143 patients presenting with a first episode of AKI, we compared the prognostic value of renal function estimated using sCr or eGFR assessed with Modification of Diet in Renal Disease (MDRD‐6), chronic kidney disease epidemiology (CKD‐EPI) and Royal Free Hospital (RFH) for renal replacement therapy (RRT) within 30 days of AKI, and 30‐ and 90‐day transplant‐free survival.
Results
eGFR was calculated on values obtained before and at admission, at presentation of AKI (D0) and 48 hours after AKI (D2).15% of patients (more commonly in alcohol + metabolic etiology; P = .049 vs other) required RRT. Transplant‐free survival at 30‐and 90‐day were 77% and 63%. Among sCr, MDRD‐6, CKD‐EPI and RFH‐eGFR, the latter predicted best RRT (HR 0.937 95% CI 0.893‐0.982, P = .007), 30‐d (HR 0.936 95% CI 0.901‐0.972, P = .001) and 90‐d (HR 0.934 95% CI 0.908‐0.972, P < .001) mortality/OLT.
Conclusions
Renal function estimated using the RFH‐eGFR calculated at D2 after AKI diagnosis is a strong predictor of RRT and of 30‐d and 90‐d transplant‐free survival. Results suggest that in cirrhosis, RFH‐eGFR may be a better indicator of prognosis in AKI than sCr.</description><subject>advanced chronic liver disease</subject><subject>chronic kidney disease</subject><subject>Cirrhosis</subject><subject>Creatinine</subject><subject>Epidemiology</subject><subject>Epidermal growth factor receptors</subject><subject>Etiology</subject><subject>Glomerular filtration rate</subject><subject>hepatorenal syndrome</subject><subject>Injuries</subject><subject>Kidney diseases</subject><subject>Kidney transplantation</subject><subject>Kidneys</subject><subject>Liver cirrhosis</subject><subject>Liver transplantation</subject><subject>Mathematical analysis</subject><subject>Medical prognosis</subject><subject>Prognosis</subject><subject>Renal function</subject><subject>Survival</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><issn>1478-3223</issn><issn>1478-3231</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kc1OGzEUha2qqElpF30BZKkbukjwL-MsEYKCFAkJQbeW47lDnTrjYM-AskN9gj5jn4QLA1kg4c2x5M9H595DyDfOphzPQQx3U66qQ_2BjFHNRArJP27vQo7I51KWjPHZTPNPZCSl5EorOSZ_L9PGRXqaAehZKuvQufj_4R-ULqxcBzW9iWkFuY8u0ybELrsupJaiAG1SpuucbtqEtKfl-bEJfkBSgx9y6ajzPcJ_Qt3ChoZ22ecnoT7k_DuVUL6QncbFAl9fdJdcn55cHZ9N5hc_z4-P5hMvjdET5ThTxiivjRYzrpyTjXbSm0ooAdJXrDZ-AcDBKwbMCLnwXNWGz2RVeyXkLtkffDHzbY8T2lUoHmJ0LaS-WKEqxoTmhxLR72_QZepzi-ms0AwXKjABUj8GyudUSobGrjNuLW8sZ_apGIvF2OdikN17cewXK6i35GsTCBwMwH2IsHnfyc7Pfw2Wj7Domks</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Rodrigues, Susana G.</creator><creator>Abraldes, Juan G.</creator><creator>Tsochatzis, Emmanouil</creator><creator>Bosch, Jaime</creator><creator>Berzigotti, Annalisa</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7T5</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5069-2461</orcidid><orcidid>https://orcid.org/0000-0003-3421-937X</orcidid><orcidid>https://orcid.org/0000-0003-4562-9016</orcidid></search><sort><creationdate>202104</creationdate><title>Royal Free Hospital‐estimated glomerular filtration rate for prognostic stratification of first acute kidney injury in cirrhosis</title><author>Rodrigues, Susana G. ; Abraldes, Juan G. ; Tsochatzis, Emmanouil ; Bosch, Jaime ; Berzigotti, Annalisa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3885-4a104884c5852914aa3f5a3c87242e3c70d8cbee1ec40e0823bc14d81937dc423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>advanced chronic liver disease</topic><topic>chronic kidney disease</topic><topic>Cirrhosis</topic><topic>Creatinine</topic><topic>Epidemiology</topic><topic>Epidermal growth factor receptors</topic><topic>Etiology</topic><topic>Glomerular filtration rate</topic><topic>hepatorenal syndrome</topic><topic>Injuries</topic><topic>Kidney diseases</topic><topic>Kidney transplantation</topic><topic>Kidneys</topic><topic>Liver cirrhosis</topic><topic>Liver transplantation</topic><topic>Mathematical analysis</topic><topic>Medical prognosis</topic><topic>Prognosis</topic><topic>Renal function</topic><topic>Survival</topic><topic>Transplantation</topic><topic>Transplants & implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rodrigues, Susana G.</creatorcontrib><creatorcontrib>Abraldes, Juan G.</creatorcontrib><creatorcontrib>Tsochatzis, Emmanouil</creatorcontrib><creatorcontrib>Bosch, Jaime</creatorcontrib><creatorcontrib>Berzigotti, Annalisa</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Liver international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rodrigues, Susana G.</au><au>Abraldes, Juan G.</au><au>Tsochatzis, Emmanouil</au><au>Bosch, Jaime</au><au>Berzigotti, Annalisa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Royal Free Hospital‐estimated glomerular filtration rate for prognostic stratification of first acute kidney injury in cirrhosis</atitle><jtitle>Liver international</jtitle><addtitle>Liver Int</addtitle><date>2021-04</date><risdate>2021</risdate><volume>41</volume><issue>4</issue><spage>819</spage><epage>827</epage><pages>819-827</pages><issn>1478-3223</issn><eissn>1478-3231</eissn><abstract>Background & Aims
Renal function is a major determinant of prognosis in patients with cirrhosis. Current guidelines only contemplate serum creatinine (sCr) to assess kidney injury. However, there are formulas to estimate glomerular filtration rate (eGFR) which better measure renal function in patients listed for liver transplantation. There is no data available on whether these formulas predict prognosis in patients with acute kidney injury (AKI).
Methods
In 143 patients presenting with a first episode of AKI, we compared the prognostic value of renal function estimated using sCr or eGFR assessed with Modification of Diet in Renal Disease (MDRD‐6), chronic kidney disease epidemiology (CKD‐EPI) and Royal Free Hospital (RFH) for renal replacement therapy (RRT) within 30 days of AKI, and 30‐ and 90‐day transplant‐free survival.
Results
eGFR was calculated on values obtained before and at admission, at presentation of AKI (D0) and 48 hours after AKI (D2).15% of patients (more commonly in alcohol + metabolic etiology; P = .049 vs other) required RRT. Transplant‐free survival at 30‐and 90‐day were 77% and 63%. Among sCr, MDRD‐6, CKD‐EPI and RFH‐eGFR, the latter predicted best RRT (HR 0.937 95% CI 0.893‐0.982, P = .007), 30‐d (HR 0.936 95% CI 0.901‐0.972, P = .001) and 90‐d (HR 0.934 95% CI 0.908‐0.972, P < .001) mortality/OLT.
Conclusions
Renal function estimated using the RFH‐eGFR calculated at D2 after AKI diagnosis is a strong predictor of RRT and of 30‐d and 90‐d transplant‐free survival. Results suggest that in cirrhosis, RFH‐eGFR may be a better indicator of prognosis in AKI than sCr.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33314543</pmid><doi>10.1111/liv.14765</doi><tpages>0</tpages><orcidid>https://orcid.org/0000-0001-5069-2461</orcidid><orcidid>https://orcid.org/0000-0003-3421-937X</orcidid><orcidid>https://orcid.org/0000-0003-4562-9016</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Liver international, 2021-04, Vol.41 (4), p.819-827 |
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| subjects | advanced chronic liver disease chronic kidney disease Cirrhosis Creatinine Epidemiology Epidermal growth factor receptors Etiology Glomerular filtration rate hepatorenal syndrome Injuries Kidney diseases Kidney transplantation Kidneys Liver cirrhosis Liver transplantation Mathematical analysis Medical prognosis Prognosis Renal function Survival Transplantation Transplants & implants |
| title | Royal Free Hospital‐estimated glomerular filtration rate for prognostic stratification of first acute kidney injury in cirrhosis |
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