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Ge J, Lai JC, Boike JR, German M, Jest N, Morelli G, Spengler E, Said A, Lee A, Hristov A, Desai AP, Junna S, Pokhrel B, Couri T, Paul S, Frenette C, Christian-Miller N, Laurito M, Verna EC, Rahim U, Goel A, Das A, Pine S, Gregory D, VanWagner LB, Kolli KP. Nonalcoholic Fatty Liver Disease and Diabetes Mellitus Are Associated With Post-Transjugular Intrahepatic Portosystemic Shunt Renal Dysfunction: An Advancing Liver Therapeutic Approaches Group Study. Liver Transpl 2021; 27:329-340. [PMID: 33217178 PMCID: PMC8053375 DOI: 10.1002/lt.25949] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/02/2020] [Accepted: 10/14/2020] [Indexed: 12/14/2022]
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertensive complications, but its effect on renal function is not well characterized. Here we describe renal function and characteristics associated with renal dysfunction at 30 days post-TIPS. Adults with cirrhosis who underwent TIPS at 9 hospitals in the United States from 2010 to 2015 were included. We defined "post-TIPS renal dysfunction" as a change in estimated glomerular filtration rate (ΔeGFR) ≤-15 and eGFR ≤ 60 mL/min/1.73 m2 or new renal replacement therapy (RRT) at day 30. We identified the characteristics associated with post-TIPS renal dysfunction by logistic regression and evaluated survival using adjusted competing risk regressions. Of the 673 patients, the median age was 57 years, 38% of the patients were female, 26% had diabetes mellitus, and the median MELD-Na was 17. After 30 days post-TIPS, 66 (10%) had renal dysfunction, of which 23 (35%) required new RRT. Patients with post-TIPS renal dysfunction, compared with those with stable renal function, were more likely to have nonalcoholic fatty liver disease (NAFLD; 33% versus 17%; P = 0.01) and comorbid diabetes mellitus (42% versus 24%; P = 0.001). Multivariate logistic regressions showed NAFLD (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.00-4.17; P = 0.05), serum sodium (Na; OR, 1.06 per mEq/L; 95% CI, 1.01-1.12; P = 0.03), and diabetes mellitus (OR, 2.04; 95% CI, 1.16-3.61; P = 0.01) were associated with post-TIPS renal dysfunction. Competing risk regressions showed that those with post-TIPS renal dysfunction were at a higher subhazard of death (subhazard ratio, 1.74; 95% CI, 1.18-2.56; P = 0.01). In this large, multicenter cohort, we found NAFLD, diabetes mellitus, and baseline Na associated with post-TIPS renal dysfunction. This study suggests that patients with NAFLD and diabetes mellitus undergoing TIPS evaluation may require additional attention to cardiac and renal comorbidities before proceeding with the procedure.
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Affiliation(s)
- Jin Ge
- University of California-San Francisco, San Francisco, CA
| | - Jennifer C Lai
- University of California-San Francisco, San Francisco, CA
| | | | - Margarita German
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | - Erin Spengler
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Adnan Said
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Alexander Lee
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Alexander Hristov
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Shilpa Junna
- College of Medicine University of Arizona, Tucson, AZ
| | | | | | - Sonali Paul
- The University of Chicago Medicine, Chicago, IL
| | | | | | - Marcela Laurito
- Columbia University College of Physicians & Surgeons, New York, NY
| | | | | | | | - Arighno Das
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stewart Pine
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dyanna Gregory
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lisa B. VanWagner
- Northwestern University Feinberg School of Medicine, Chicago, IL,Corresponding Author Lisa B. VanWagner, MD, MSc, Assistant Professor of Medicine-Gastroenterology & Hepatology and Preventive Medicine, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 676 N. St Clair - Suite 1400, Chicago, Illinois 60611, , Fax: 312-695-3999
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Desai N, Neugarten J, Dominguez M, Golestaneh L. Hepatic vein pressure predicts GFR in cirrhotic patients with hemodynamic kidney dysfunction. Physiol Rep 2017; 5:5/11/e13301. [PMID: 28611152 PMCID: PMC5471440 DOI: 10.14814/phy2.13301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The role of “nephrocongestion” in hemodynamic renal disease is understudied. Intra‐abdominal hypertension accompanies liver disease and renal disease. Our hypothesis states that in those patients with liver disease, hepatic vein pressure measured during a transjugular intrahepatic portosystemic shunt (TIPS) procedure reflects intra‐abdominal pressure and predicts estimated glomerular filtration rate (eGFR). We gathered data from our clinical database and chart review on a cohort of cirrhotic patients who received TIPS at Montefiore as part of their clinical care between 2004 and 2014. We evaluated association of demographic and measured variables with eGFR in those subjects without end‐stage renal disease (ESRD). Using multivariate regression, we examined the relationship between eGFR and hepatic vein pressure while adjusting for age, proteinuria, and ultrasound evidence for parenchymal kidney disease. The mean age of the subjects was 57 years old. Two thirds of the patients were male, 23% were White, and 20% were Black. A higher percentage of patients with chronic kidney disease (CKD), as determined by lower than 60 mL/min/1.73 m2, had proteinuria and ultrasound evidence for parenchymal kidney disease. A multivariate linear regression showed a significant and negative association between hepatic vein pressure and eGFR when adjusting for age, race, and proteinuria. Hepatic vein pressure is negatively and significantly associated with eGFR in those patients with liver failure. This finding has major implications for the way we evaluate hemodynamic renal disease.
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Affiliation(s)
- Neel Desai
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medicine/Renal Division, Bronx, New York
| | - Joel Neugarten
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medicine/Renal Division, Bronx, New York
| | - Mary Dominguez
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medicine/Renal Division, Bronx, New York
| | - Ladan Golestaneh
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medicine/Renal Division, Bronx, New York
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