Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy.
Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
Dig Liver Dis. 2022 Aug;54(8):1101-1108. doi: 10.1016/j.dld.2021.09.008. Epub 2021 Oct 5.
Transjugular intrahepatic porto-systemic shunt (TIPS) ameliorates renal function in type-2 hepatorenal syndrome (HRS). Available evidence is based on 'old' HRS diagnostic criteria, and not on the current definition of HRS - chronic kidney disease (HRS-CKD). Among patients who underwent TIPS for refractory ascites over the last 12 years, we investigated clinical and renal function evolution of those with HRS-CKD.
among 212 patients, 41 with HRS-CKD were included. Renal function was evaluated for 12 months after TIPS, along with management of ascites and transplant-free survival (TFS).
renal function significantly improved already one week after TIPS [serum creatinine (sCr): 1.37 ± 0.23 vs 1.94 ± 0.54 mg/dl, p< 0.001]; the amelioration was maintained during the whole follow-up and was observed in every CKD stage, defined according to baseline estimated Glomerular Filtration Rate (eGFR). sCr and eGFR became comparable between different CKD stages after only one week, whilst significantly different at baseline. TIPS led to a remarkable improvement in the control of ascites in all CKD stages and no significant differences in TFS were recorded.
TIPS led to an early, substantial and persistent improvement in renal function in patients with HRS-CKD, irrespective of their baseline CKD stage.
经颈静脉肝内门体分流术（TIPS）可改善 2 型肝肾综合征（HRS）患者的肾功能。现有证据基于“旧”的 HRS 诊断标准，而不是当前的 HRS-慢性肾脏病（HRS-CKD）定义。在过去 12 年中，我们对因难治性腹水而行 TIPS 的 212 例患者进行了研究，以调查 HRS-CKD 患者的临床和肾功能演变。
在 212 例患者中，纳入了 41 例 HRS-CKD 患者。在 TIPS 后 12 个月内评估肾功能，同时评估腹水管理和无移植生存（TFS）情况。
TIPS 后一周肾功能即显著改善[血肌酐（sCr）：1.37±0.23 比 1.94±0.54 mg/dl，p<0.001]；整个随访期间，这种改善得以维持，且在根据基线估计肾小球滤过率（eGFR）定义的每个 CKD 阶段均观察到。sCr 和 eGFR 在 TIPS 后仅一周即变得可比，而在基线时差异显著。TIPS 可显著改善所有 CKD 阶段的腹水控制，且 TFS 无显著差异。
TIPS 可使 HRS-CKD 患者的肾功能早期、显著和持久改善，与患者的基线 CKD 阶段无关。
