Acute Kidney Injury, Cirrhosis, Diastolic Function, Hepatorenal Syndrome
Conditions
Keywords
cirrhosis, hepatorenal syndrome, acute kidney injury, diastolic function
Brief summary
This prospective study focuses on the interest of the echocardiography for cirrhotic patients, who present acute kidney injury corresponding to the criteria of hepatorenal syndrome. This echocardiography will be done before the volemic expansion and the final diagnostic of hepatorenal syndrome or prerenal azotemia. The primary endpoint is to describe the hemodynamic characteristics of this population at the time of acute kidney injury and their association with diagnostic of hepatorenal syndrome or prerenal azotemia. Patients with elevated filling pressure, predicting poor outcome of volemic expansion will be excluded of the study after the echocardiography and will not undergo volemic expansion but appropriate management.
Interventions
PROCEDUREEchocardiography
Sponsors
Hospices Civils de Lyon
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients \> 18 years * written consent for the participation of the study * cirrhosis with portal hypertension and ascite * acute kidney injury according to AKIN criteria (rapid increase of creatinine (48 hours) \> 26.4 µmol or \> 50% comparing with baseline). Baseline creatinine is the last value of creatinine before admission or creatinine at the admission if stable during 5 days. * absence of argument for acute tubular necrosis or other organic acute renal injury * absence of argument for shock
Exclusion criteria
* pregnant women * volemic expansion before echocardiography * portal thrombosis * presence of TIPSS * history of cardiac or renal pathology * atrial fibrillation * cardiac valvulopathy * technical limitation due to echogenicity
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hemodynamic features assessed by echocardiography before the volemic expansion of cirrhotic patients with acute renal injury corresponding to the criteria of hepatorenal syndrome. | At Day0 : at the time of diagnostic of acute kidney injury, before volemic expansion. | Systolic and diastolic function assessment, filling pressures, pulmonary arterial hypertension |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Tolerance of volemic expansion, as recommended by international guidelines | After 48 hours of volemic expansion | Clinical tolerance of volemic expansion, acute pulmonary oedema |
| Response to vasoconstrictor treatment of hepatorenal syndrome, in case of diagnostic of hepatorenal syndrome | 1 month after inclusion | Renal function recovery, renal replacement therapy, liver transplantation |
| Mortality | 1 month after inclusion | — |
Countries
France
Outcome results
None listed