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Causes of renal failure in patients with decompensated cirrhosis and its impact in hospital mortality.

Abstract

BACKGROUND
Renal failure (RF) is reported to occur in 11-49% of the patients with decompensated end-stage liver disease (ESLD) and has been associated with increased mortality, particularly in the occurrence of hepatorenal syndrome (HRS) type 1.
AIMS
To evaluate the frequency and outcome of RF in patients admitted to the hospital due to decompensated ESLD and to assess the impact of the underlying cause of RF on survival.
MATERIAL AND METHODS
Four hundred and six patients (65% males, mean age 62 ± 12 years) with decompensated ESLD were evaluated for the occurrence of RF (defined as serum creatinine ³ 1.5 mg/mL). The underlying cause of RF was reckoned in each subject and compared to outcome.
RESULTS
Renal failure was observed in 39% of the patients at admission and in 10% of the subjects during hospitalization. Mortality was significantly higher in subjects with RF (26 vs. 1%, p < 0.000001). Hypovolemia, bacterial infections, parenchymal kidney diseases and HRS were identified as causes of RF in, respectively, 40, 32, 15 and 12% of the cases. Mortality was significantly higher in those subjects with HRS type 1 and bacterial infections, when compared to other causes of RF.
CONCLUSIONS
Renal failure occurs in nearly half of the patients with decompensated ESLD. It is most commonly caused by hypovolemia and bacterial infections. Occurrence of RF has an adverse impact in patient survival, particularly in those subjects with bacterial infections and HRS type 1, prone to develop progressive renal dysfunction despite intensive medical care.

Authors

Carvalho GC, Regis Cde A, Kalil JR, Cerqueira LA, Barbosa DS, Motta MP, da Silva Nery M, Pires Soares MA, Zollinger CC, Bittencourt PL

Source

Annals of hepatology 11:1 pg 90-5

MeSH

Age Factors
Aged
Bacterial Infections
Comorbidity
Disease Progression
End Stage Liver Disease
Female
Hepatorenal Syndrome
Hospital Mortality
Humans
Hypovolemia
Kidney Diseases
Liver Cirrhosis
Male
Middle Aged
Prevalence
Renal Insufficiency
Retrospective Studies
Survival Rate

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22166566