Abstract
Renal function impairment (RFI) contributes to poor prognosis in cirrhotic patients. However, there have been no studies that seek to identify the effect of different types of RFI on the mortality of cirrhotic patients. We used the National Health Insurance Database, derived from the Taiwan National Health Insurance Program, to identify 44365 cirrhotic patients between January 1, 2007 and December 31, 2007. RFI was identified in 2832 cirrhotic patients, including 1075 with acute renal failure (ARF) (169 with hepatorenal syndrome, HRS; 906 with non-hepatorenal syndrome, NHRS), 705 with chronic kidney disease (CKD), and 1052 with end stage renal disease (ESRD). After Cox proportional hazard regression analysis adjusted by gender, age, and comorbid disorders, the 30-day, 30 to 90-day, 90-day to 1-year, and 1 to 3-year mortality hazard ratios (HR) compared to the non-RFI group were: (ARF) 5.19 (4.70–5.74), 3.23 (2.76–3.77), 1.51 (1.26–1.81), and 1.35 (1.13–1.61), respectively; (CKD) 2.70 (2.30–3.18), 2.03 (1.66–2.49), 1.60 (1.34–1.90), and 1.26 (1.06–1.49), respectively; and (ESRD) 1.42 (1.17–1.72), 1.62 (1.35–1.94), 1.90 (1.68–2.15), and 1.67 (1.48–1.89), respectively. Compared to NHRS, the 30-day, 30 to 90-day, 90-day to 1-year, and 1 to 3-year mortality HRs of HRS were 1.03 (0.80–1.32), 2.13 (1.46–3.11), 1.58 (0.90–2.75), and 2.51 (1.41–4.48), respectively, in cirrhotic patients with ARF. These results indicate the effects of CKD and ESRD on the mortality of cirrhotic patients are distributed equally in every survival stage, whereas the effect of ARF appears only in the early stage. Compared to NHRS, HRS contributes to a higher mortality risk at the late survival stage.
Highlights
About 20% of inpatients with decompensated cirrhosis have renal function impairment (RFI) [1]
We found that RFI contributed to a poor prognosis for cirrhotic patients with spontaneous bacterial peritonitis, and cirrhotic patients with end stage renal disease (ESRD) had a better 3-year survival than those with Chronic kidney disease (CKD) [7, 8]
This is the first nationwide population-based cohort study to identify the effect of variable forms of RFI on mortality in cirrhotic patients
Summary
About 20% of inpatients with decompensated cirrhosis have renal function impairment (RFI) [1]. There are two forms of RFI, acute and chronic. Acute renal failure (ARF), a form of acute RFI, is attributed primarily to bacterial infection, gastrointestinal bleeding, or medication in cirrhotic patients. Hepatorenal syndrome (HRS), a special form of ARF in cirrhotic patients, is the ultimate result of arterial under-filling due to severe splanchnic and systemic vasodilatation [2]. According to the course of RFI, there are two types of HRS. Type 1 HRS progresses rapidly leading to renal failure in less than two weeks. Chronic kidney disease (CKD) and end stage renal disease (ESRD) are two chronic forms of RFI. Chronic RFI in cirrhotic patients is often attributed to diabetes mellitus, hypertension, glomerulonephritis, or nephrosclerosis [3]. Compared to CKD, patents with ESRD have little residual renal function and require maintenance dialysis for long-term vital organ replacement
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