Decompensated Cirrhosis
Conditions
Brief summary
Acute kidney injury (AKI) is the sudden loss of kidney function that occurs frequently in hospitalised patients with cirrhosis. * It develops in up to 53% and is independently associated with high short-term mortality. * A diagnosis of AKI (even stage 1 AKI) has been shown to be associated with an increased risk of long-term mortality at 30-day, 90-day and 1-year, compared to patients without AKI, even when there is recovery of AKI. * Risk factors with the strongest association for developing AKI include CKD, sepsis, spontaneous bacterial peritonitis (SBP), and presence of ascites. * AKI in cirrhosis is also associated with development of de-novo chronic kidney disease (CKD) , progressive loss of kidney function in patients with pre-existing CKD,recurrent AKI (i.e., AKI on top of CKD) and other organ failures * Kidney dysfunction in patients with cirrhosis is associated with a marked increase in mortality compared with patients without kidney dysfunction. * The accurate estimation of kidney function in patients with cirrhosis is hence crucial for prognosis, treatment strategies, and decisions regarding simultaneous liver-kidney transplantation (SLKT). * Although measured GFR(mGFR) may be ideal for assessing kidney function, it is costly, time-consuming, and challenging to perform frequently in fluctuating kidney function. Therefore, GFR is most commonly estimated using serum creatinine (sCr)-based or cystatin C (CysC)-based equations
Interventions
None listed
Sponsors
Institute of Liver and Biliary Sciences, India
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Patients of cirrhosis with ascites with stable renal functions in last 7 days (variability in gfr \< 15 % and no AKI).
Exclusion criteria
1. Patients with age \<18 or more than 65 years 2. Obstructive uropathy or intrinsic kidney disease 3. Patients with multiorgan failure or requiring mechanical ventilation 4. Patients who had previously undergone Liver or Kidney transplant 5. Patients with missing laboratory measurements within 24 hours of admission 6. HCC 7. Pregnant 8. Lack of baseline serum creatinine 9. Need of renal replacement therapy 10. HVOTO 11. Severe comorbid cardiopulmonary diseases or extrahepatic malignancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Major Adverse Kidney Events at 1 year. | 1 year | Make is defined as the composite outcome of ≥25% decline in estimated-glomerular-filtration-rate (eGFR) compared with baseline with the development of de-novo chronic-kidney-disease (CKD) stage ≥3 or CKD progression (≥50% reduction in eGFR compared with baseline or new haemodialysis or death. |
Secondary
| Measure | Time frame |
|---|---|
| Validation and comparision of new equation with known equations of GFR | 1 year |
| Cumulative incidence of AKI and its impact on MAKE | 1 year |
| AKD and CKD development | 1 year |
| Development of Liver related decompensating events: worsening of ascites, acute Variceal bleed,SBP and non-SBP infections, hepatic encephalopathy,Hepatocellular carcinoma | 1 year |
| Need for Liver transplant or simultaneous liver kidney transplant | 1 year |
| Numbers of hospitalisations | 1 year |
Countries
India
Contacts
CONTACTDr Gnana Kavitha, MD
CONTACTDr Rakhi Maiwall, DM
Outcome results
None listed