Kogiso Tomomi, Ogasawara Yuri, Sagawa Takaomi, Taniai Makiko, Tokushige Katsutoshi
Institute of Gastroenterology, Department of Internal Medicine Tokyo Women's Medical University Shinjuku-ku Tokyo Japan.
JGH Open. 2021 Nov 1;5(11):1298-1305. doi: 10.1002/jgh3.12672. eCollection 2021 Nov.
Acute kidney injury (AKI) is a life-threatening complication of liver cirrhosis. Here, we evaluated the risk factors and characteristics of AKI in cirrhosis.
PATIENTS/METHODS: This was a single-center retrospective study. A total of 199 Japanese patients with decompensated liver cirrhosis (104 men, median age 61 years) were enrolled and received tolvaptan orally. Survival rates and new onset of AKI were monitored, and risk factors were evaluated.
Forty-six patients (23.1%) suffered an AKI complication and exhibited significantly poorer survival ( < 0.01). The rates of hepatic encephalopathy ( < 0.01) and chronic kidney disease (CKD; = 0.02) were significantly increased in patients with AKI. The rate of proton pump inhibitor (PPI)/H2 blocker treatment ( = 0.04) was significantly lower, whereas that of ascites drainage was significantly higher in the AKI cases ( < 0.01). The AKI risk was significantly increased in patients with hepatic encephalopathy (HR 4.18, 95% CI 1.618-10.771). In contrast, the incidence of AKI was significantly lower in patients with a higher serum albumin level (HR 0.36, 95% CI 0.142-0.914, = 0.03). Treatment with PPI/H2 blockers (HR 0.30, 95% CI 0.126-0.711, < 0.01) or kanamycin/rifaximin (HR 0.26, 95% CI 0.075-0.929, = 0.04) was significantly associated with a reduced risk of AKI development.
AKI incidence was increased in patients with decreased liver function and was associated with poor survival. PPI/H2 blocker or kanamycin/rifaximin treatment may reduce the risk of AKI.
急性肾损伤（AKI）是肝硬化的一种危及生命的并发症。在此，我们评估了肝硬化患者发生AKI的危险因素及特征。
患者/方法：这是一项单中心回顾性研究。共纳入199例日本失代偿期肝硬化患者（104例男性，中位年龄61岁），并给予口服托伐普坦治疗。监测生存率及AKI的新发情况，并评估危险因素。
46例患者（23.1%）发生了AKI并发症，且生存率显著更低（<0.01）。AKI患者的肝性脑病发生率（<0.01）及慢性肾脏病（CKD；=0.02）发生率显著升高。质子泵抑制剂（PPI）/H2受体阻滞剂治疗率（=0.04）显著更低，而AKI病例的腹水引流率显著更高（<0.01）。肝性脑病患者的AKI风险显著升高（风险比4.18，95%置信区间1.618 - 10.771）。相比之下，血清白蛋白水平较高的患者AKI发生率显著更低（风险比0.36，95%置信区间0.142 - 0.914，=0.03）。PPI/H2受体阻滞剂治疗（风险比0.30，95%置信区间0.126 - 0.711，<0.01）或卡那霉素/利福昔明治疗（风险比0.26，95%置信区间0.075 - 0.929，=0.04）与AKI发生风险降低显著相关。
肝功能下降患者的AKI发生率升高，且与生存率低相关。PPI/H2受体阻滞剂或卡那霉素/利福昔明治疗可能降低AKI风险。
