Abstract
The role of “nephrocongestion” in hemodynamic renal disease is understudied. Intra‐abdominal hypertension accompanies liver disease and renal disease. Our hypothesis states that in those patients with liver disease, hepatic vein pressure measured during a transjugular intrahepatic portosystemic shunt (TIPS) procedure reflects intra‐abdominal pressure and predicts estimated glomerular filtration rate (eGFR). We gathered data from our clinical database and chart review on a cohort of cirrhotic patients who received TIPS at Montefiore as part of their clinical care between 2004 and 2014. We evaluated association of demographic and measured variables with eGFR in those subjects without end‐stage renal disease (ESRD). Using multivariate regression, we examined the relationship between eGFR and hepatic vein pressure while adjusting for age, proteinuria, and ultrasound evidence for parenchymal kidney disease. The mean age of the subjects was 57 years old. Two thirds of the patients were male, 23% were White, and 20% were Black. A higher percentage of patients with chronic kidney disease (CKD), as determined by lower than 60 mL/min/1.73 m2, had proteinuria and ultrasound evidence for parenchymal kidney disease. A multivariate linear regression showed a significant and negative association between hepatic vein pressure and eGFR when adjusting for age, race, and proteinuria. Hepatic vein pressure is negatively and significantly associated with eGFR in those patients with liver failure. This finding has major implications for the way we evaluate hemodynamic renal disease.
Highlights
Hemodynamic renal disease, known as prerenal azotemia, is characterized by a reduction in glomerular filtration rate that is reversible and presumably a result of decreased renal perfusion (Schrier 2007; Schrier et al 2012)
We identified a total of 439 procedures and utilized chart review to collect the following demographic variables: age, sex, race, history of diabetes mellitus (DM), history of hepatitis C, the most recent echocardiogram derived ejection fraction (EF) before the procedure, and the most recent serum creatinine and CLG derived estimated glomerular filtration rate using the Modification of Diet in Renal Disease (MDRD) formula
The mean estimated glomerular filtration rate (eGFR) of the entire cohort was 84 mL/min/m2. In those patients identified as having chronic kidney disease (CKD) stage 3 or above, the prevalence of parenchymal renal disease was 25% and that of proteinuria was 55%
Summary
Hemodynamic renal disease, known as prerenal azotemia, is characterized by a reduction in glomerular filtration rate (eGFR) that is reversible and presumably a result of decreased renal perfusion (Schrier 2007; Schrier et al 2012). Etiologies for hemodynamic renal disease include conditions wherein total body salt water is increased but “effective” intravascular volume is reduced. Examples include cardiorenal syndrome in heart failure (HF) and hepatorenal syndrome in cirrhosis (Schrier 2007; Schrier et al 2012). The mechanism for renal dysfunction in these settings is yet to be fully elucidated. A thorough understanding of hemodynamic mechanisms underlying renal dysfunction in these disorders is essential for proper diagnosis and has significant implications for management strategies
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