Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
German Centre for Infection Research, HepNet Study-House of the German Liver Foundation, 30625, Hannover, Germany.
Sci Rep. 2023 Oct 14;13(1):17486. doi: 10.1038/s41598-023-44299-w.
Patients with decompensated cirrhosis are at risk of developing acute kidney injury (AKI). Studies have suggested that inhibition of the Renin-Angiotensin System (RAS) has certain nephro- and hepatoprotective effects in patients with compensated liver disease. This study aimed to investigate the clinical impact of RAS-Inhibitors in individuals with decompensated liver cirrhosis. Overall, 1181 consecutive hospitalized patients with ascites that underwent paracentesis were considered for this retrospective study. In total, 667 patients with decompensated cirrhosis fulfilled the inclusion criteria and were finally analyzed. RAS-Inhibitor intake was documented in 41 patients (7%). First, 28-day incidences of AKI and grade III AKI of all patients with RAS-Inhibitors were compared to those without intake. Afterwards, propensity score matching was conducted in a 3:1 manner. Here, incidence of further renal endpoints such as need of hemodialysis were analyzed in detail. In the unmatched setting, intake of RAS-Inhibitors was not associated with an increased 28 day-incidence of AKI (P = 0.76) or LTx-free survival (P = 0.60). However, 28 day-incidence of grade III AKI was significantly lower in patients with RAS-Inhibitor intake (P < 0.001). In the matched setting, 28 day-incidence of AKI did not differ (P = 0.81), while grade III AKI was significantly less frequent in the RAS-Inhibitor group (P < 0.001). Need for hemodialysis was also significantly lower in patients with RAS-Inhibitors (P = 0.03) and LTx-free survival was comparable between both groups (P = 0.52). Thus, this study suggests that intake of RAS-Inhibitors is associated with decreased incidences of grade III AKI and need of hemodialysis in patients with decompensated liver disease.
失代偿性肝硬化患者有发生急性肾损伤（AKI）的风险。研究表明，在代偿性肝病患者中，肾素-血管紧张素系统（RAS）抑制具有一定的肾和肝保护作用。本研究旨在探讨 RAS 抑制剂在失代偿性肝硬化患者中的临床影响。
共有 1181 例接受经皮穿刺引流术的腹水住院患者被纳入本回顾性研究。共有 667 例符合纳入标准的失代偿性肝硬化患者最终纳入分析。41 例（7%）患者记录了 RAS 抑制剂的使用情况。首先，将所有使用 RAS 抑制剂的患者与未使用 RAS 抑制剂的患者的 28 天 AKI 发生率和 III 级 AKI 发生率进行比较。然后，采用 3:1 的倾向评分匹配。在此，详细分析了进一步的肾脏终点事件（如需要血液透析）的发生率。
在未匹配的情况下，RAS 抑制剂的使用与 28 天 AKI 发生率（P=0.76）或 LTx 无失败生存率（P=0.60）的增加无关。然而，RAS 抑制剂使用者的 28 天 III 级 AKI 发生率显著降低（P<0.001）。在匹配的情况下，28 天 AKI 的发生率没有差异（P=0.81），但 RAS 抑制剂组的 III 级 AKI 发生率显著降低（P<0.001）。RAS 抑制剂使用者的血液透析需求也显著降低（P=0.03），两组间的 LTx 无失败生存率相当（P=0.52）。
因此，本研究表明，在失代偿性肝病患者中，RAS 抑制剂的使用与 III 级 AKI 发生率和血液透析需求的降低相关。
