Umemura Takeji, Joshita Satoru, Shibata Soichiro, Sugiura Ayumi, Yamazaki Tomoo, Fujimori Naoyuki, Matsumoto Akihiro, Tanaka Eiji
Department of Medicine, Division of Hepatology and Gastroenterology, Shinshu University School of Medicine.
Research Center for Next Generation Medicine, Shinshu University, Matsumoto, Nagano, Japan.
Medicine (Baltimore). 2019 Feb;98(6):e14475. doi: 10.1097/MD.0000000000014475.
Although renal impairment is a frequent complication in cirrhosis that is associated with a poor prognosis, little has been reported on the clinical significance of renal impairment in cirrhosis in Japan. This retrospective study assessed the impact of renal impairment on mortality in Japanese cirrhosis patients taking conventional diuretics.A total of 157 patients with cirrhosis receiving diuretic treatment were evaluated for the presence and status of renal impairment, defined as an increase in serum creatinine of ≥ 0.3 mg/dL or by ≥ 50%, and then classified according to the International Club of Ascites (ICA)-Acute Kidney Injury (AKI) staging system.Eighty of 157 (51%) patients fulfilled the criteria for renal impairment. Thirty-four (43%) patients had ICA-AKI stage 1, 32 (40%) stage 2, and 14 (18%) stage 3. Multivariate analysis revealed female gender (hazard ratio [HR] = 0.407, 95% confidence interval = 0.193-0.857; P = .018), ALT ≥35 IU/L (HR = 3.841, 95% confidence interval = 1.785-8.065; P = .001), and the presence of renal impairment (HR = 4.275, 95% confidence interval = 1.962-9.312; P < .001) as independent factors significantly increasing the risk of mortality. Cumulative survival rates increased significantly with ICA-AKI stage (log-rank test, P = .009).Renal impairment was a predictive marker of mortality in Japanese patients with cirrhosis. Stratification according to ICA-AKI criteria of kidney function impairment may be a good prognostic indicator of cirrhosis outcome.
尽管肾功能损害是肝硬化常见的并发症，且与预后不良相关，但在日本，关于肝硬化患者肾功能损害的临床意义鲜有报道。这项回顾性研究评估了肾功能损害对接受传统利尿剂治疗的日本肝硬化患者死亡率的影响。
总共157例接受利尿剂治疗的肝硬化患者接受了肾功能损害的存在和状态评估，肾功能损害定义为血清肌酐升高≥0.3mg/dL或升高≥50%，然后根据国际腹水俱乐部（ICA）-急性肾损伤（AKI）分期系统进行分类。
157例患者中有80例（51%）符合肾功能损害标准。34例（43%）患者为ICA-AKI 1期，32例（40%）为2期，14例（18%）为3期。多因素分析显示，女性（风险比[HR]=0.407，95%置信区间=0.193-0.857；P=0.018）、ALT≥35IU/L（HR=3.841,95%置信区间=1.785-8.065；P=0.001）以及存在肾功能损害（HR=4.275，95%置信区间=1.962-9.312；P<0.001）是显著增加死亡风险的独立因素。累积生存率随ICA-AKI分期显著增加（对数秩检验，P=0.009）。
肾功能损害是日本肝硬化患者死亡的预测指标。根据ICA-AKI肾功能损害标准进行分层可能是肝硬化预后的良好指标。
