Skip to main content
Erschienen in: Journal of Gastroenterology 1/2021

21.09.2020 | Original Article—Liver, Pancreas, and Biliary Tract

Impact of acute kidney injury on prognosis and the effect of tolvaptan in patients with hepatic ascites

verfasst von: Yasunari Hiramine, Hirofumi Uto, Seiichi Mawatari, Shuji Kanmura, Yasushi Imamura, Takuya Hiwaki, Akiko Saishoji, Manei Oku, Koichi Tokushige, Shigeho Maenohara, Akio Ido

Erschienen in: Journal of Gastroenterology | Ausgabe 1/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

In hepatic cirrhosis, ascites and acute kidney injury (AKI) portend poor prognosis. We examined the incidence and characteristics of AKI in patients with hepatic ascites and the impact of diuretics on AKI onset.

Methods

This study included 337 patients with hepatic ascites treated with oral diuretics during September 2013–June 2019. Incidence of AKI, cumulative survival by AKI status, and prognostic factors were investigated.
Patients were divided into those treated with tolvaptan (TLV) [TLV group (n = 244)] and those not treated with TLV [control group (n = 93)]. After propensity score matching, the incidence of AKI and changes in renal function and doses of diuretics were compared.

Results

The incidence of AKI overall was 35% (n = 118). Patients with AKI had a significantly worse survival than those without AKI (P = 0.001), indicating that AKI is an independent prognostic factor for hepatic ascites (P = 0.025).
After adjustment for background factors in the two groups (n = 77 each), the TLV group had a significantly lower incidence of AKI (27.6% vs. 44.7%, P = 0.028). While renal function worsened with higher natriuretic agent doses in the control group, no significant change was observed in the TLV group, suggesting that TLV is an independent prognostic factor for AKI onset.

Conclusions

Our study suggests that concomitant AKI significantly worsens survival in Japanese patients with hepatic ascites, and TLV and natriuretic agent combination therapy might lead to an excellent synergistic therapeutic effect of hepatic ascites and inhibition of AKI onset.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Gines P, Quintero E, Arroyo V, et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology. 1987;7:122–8.PubMed Gines P, Quintero E, Arroyo V, et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology. 1987;7:122–8.PubMed
2.
Zurück zum Zitat European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53:397–417. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53:397–417.
3.
Zurück zum Zitat Arroyo V, Gines P. Mechanism of sodium retention and ascites formation in cirrhosis. J Hepatol. 1993;17:24–8. Arroyo V, Gines P. Mechanism of sodium retention and ascites formation in cirrhosis. J Hepatol. 1993;17:24–8.
4.
Zurück zum Zitat Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical practice guideline for acute kidney injury. Kidney Int. 2012;2:1–138. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical practice guideline for acute kidney injury. Kidney Int. 2012;2:1–138.
5.
Zurück zum Zitat Kellum JA, Ronco C, Bellomo R. Acute kidney disease and the community. Lancet. 2016;387:1974–6.PubMed Kellum JA, Ronco C, Bellomo R. Acute kidney disease and the community. Lancet. 2016;387:1974–6.PubMed
6.
Zurück zum Zitat Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology. 2008;48:2064–77.PubMed Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology. 2008;48:2064–77.PubMed
7.
Zurück zum Zitat Belcher JM, Sanyal AJ, Peixoto AJ, et al. Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury. Hepatology. 2014;60:622–32.PubMedPubMedCentral Belcher JM, Sanyal AJ, Peixoto AJ, et al. Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury. Hepatology. 2014;60:622–32.PubMedPubMedCentral
8.
Zurück zum Zitat Fagundes C, Barreto R, Guevara M, et al. A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis. J Hepatol. 2013;59:474–81.PubMed Fagundes C, Barreto R, Guevara M, et al. A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis. J Hepatol. 2013;59:474–81.PubMed
9.
Zurück zum Zitat Piano S, Rosi S, Maresio G, et al. Evaluation of the Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites. J Hepatol. 2013;59:482–9.PubMed Piano S, Rosi S, Maresio G, et al. Evaluation of the Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites. J Hepatol. 2013;59:482–9.PubMed
10.
Zurück zum Zitat Tsien CD, Rabie R, Wong F. Acute kidney injury in decompensated cirrhosis. Gut. 2013;62:131–7.PubMed Tsien CD, Rabie R, Wong F. Acute kidney injury in decompensated cirrhosis. Gut. 2013;62:131–7.PubMed
11.
Zurück zum Zitat Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut. 2015;64:531–7.PubMed Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut. 2015;64:531–7.PubMed
12.
Zurück zum Zitat European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69:406–60. European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69:406–60.
13.
Zurück zum Zitat Bassegoda O, Huelin P, Ariza X, et al. Development of chronic kidney disease after acute kidney injury in patients with cirrhosis is common and impairs clinical outcomes. J Hepatol. 2020;72:1132–9.PubMed Bassegoda O, Huelin P, Ariza X, et al. Development of chronic kidney disease after acute kidney injury in patients with cirrhosis is common and impairs clinical outcomes. J Hepatol. 2020;72:1132–9.PubMed
14.
Zurück zum Zitat Cullaro G, Park M. “Normal” creatinine levels predict persistent kidney injury and waitlist mortality in outpatients with cirrhosis. Hepatology. 2018;68:1953–60.PubMedPubMedCentral Cullaro G, Park M. “Normal” creatinine levels predict persistent kidney injury and waitlist mortality in outpatients with cirrhosis. Hepatology. 2018;68:1953–60.PubMedPubMedCentral
15.
Zurück zum Zitat Huelin P, Solà E, Elia C, et al. Neutrophil gelatinase-associated lipocalin for assessment of acute kidney injury in cirrhosis: a prospective study. Hepatology. 2019;70:319–33.PubMed Huelin P, Solà E, Elia C, et al. Neutrophil gelatinase-associated lipocalin for assessment of acute kidney injury in cirrhosis: a prospective study. Hepatology. 2019;70:319–33.PubMed
16.
Zurück zum Zitat Laffi G, La Villa G, Carloni V, et al. Loop diuretic therapy in liver cirrhosis with ascites. J Cardiovasc Pharmacol. 1993;22(Suppl 3):S51–S5858.PubMed Laffi G, La Villa G, Carloni V, et al. Loop diuretic therapy in liver cirrhosis with ascites. J Cardiovasc Pharmacol. 1993;22(Suppl 3):S51–S5858.PubMed
17.
Zurück zum Zitat Costello-Boerrigter LC, Smith WB, Boerrigter G, et al. Vasopressin-2-receptor antagonism augments water excretion without changes in renal hemodynamics or sodium and potassium excretion in human heart failure. Am J Physiol Renal Physiol. 2006;290:F273–F278278.PubMed Costello-Boerrigter LC, Smith WB, Boerrigter G, et al. Vasopressin-2-receptor antagonism augments water excretion without changes in renal hemodynamics or sodium and potassium excretion in human heart failure. Am J Physiol Renal Physiol. 2006;290:F273–F278278.PubMed
18.
Zurück zum Zitat Imamura T, Kinugawa K, Fujino T, et al. Increased urine aquaporin-2 relative to plasma arginine vasopressin is a novel marker of response to tolvaptan in patients with decompensated heart failure. Circ J. 2014;78:2240–9.PubMed Imamura T, Kinugawa K, Fujino T, et al. Increased urine aquaporin-2 relative to plasma arginine vasopressin is a novel marker of response to tolvaptan in patients with decompensated heart failure. Circ J. 2014;78:2240–9.PubMed
19.
Zurück zum Zitat Sakaida I, Kawazoe S, Kajimura K, et al. Tolvaptan for improvement of hepatic edema: A phase 3, multicenter, randomized, double-blind, placebo-controlled trial. Hepatol Res. 2014;44:73–82.PubMed Sakaida I, Kawazoe S, Kajimura K, et al. Tolvaptan for improvement of hepatic edema: A phase 3, multicenter, randomized, double-blind, placebo-controlled trial. Hepatol Res. 2014;44:73–82.PubMed
20.
Zurück zum Zitat Sakaida I, Nakajima K, Okita K, et al. Can serum albumin level affect the pharmacological action of tolvaptan in patients with liver cirrhosis? A post hoc analysis of previous clinical trials in Japan. J Gastroenterol. 2015;50:1047–53.PubMedPubMedCentral Sakaida I, Nakajima K, Okita K, et al. Can serum albumin level affect the pharmacological action of tolvaptan in patients with liver cirrhosis? A post hoc analysis of previous clinical trials in Japan. J Gastroenterol. 2015;50:1047–53.PubMedPubMedCentral
21.
Zurück zum Zitat Fukui H, Saito H, Ueno Y, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol. 2016;51:629–50.PubMed Fukui H, Saito H, Ueno Y, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol. 2016;51:629–50.PubMed
22.
Zurück zum Zitat Iwamoto T, Maeda M, Saeki I, Hidaka I, Tajima K, Ishikawa T, et al. Analysis of tolvaptan non-responders and outcomes of tolvaptan treatment of ascites. J Gastroenterol Hepatol. 2019;34:1231–5.PubMed Iwamoto T, Maeda M, Saeki I, Hidaka I, Tajima K, Ishikawa T, et al. Analysis of tolvaptan non-responders and outcomes of tolvaptan treatment of ascites. J Gastroenterol Hepatol. 2019;34:1231–5.PubMed
23.
Zurück zum Zitat Sakaida I, Terai S, Kurosaki M, Okada M, Hirano T, Fukuta Y. Real-world effectiveness and safety of tolvaptan in liver cirrhosis patients with hepatic edema: results from a post-marketing surveillance study (START study). J Gastroenterol. 2020;55:800–10.PubMedPubMedCentral Sakaida I, Terai S, Kurosaki M, Okada M, Hirano T, Fukuta Y. Real-world effectiveness and safety of tolvaptan in liver cirrhosis patients with hepatic edema: results from a post-marketing surveillance study (START study). J Gastroenterol. 2020;55:800–10.PubMedPubMedCentral
24.
Zurück zum Zitat Hiramine Y, Uojima H, Nakanishi H, Hiramatsu A, Iwamoto T, Kimura M, et al. Response criteria of tolvaptan for the treatment of hepatic edema. J Gastroenterol. 2018;53:258–68.PubMed Hiramine Y, Uojima H, Nakanishi H, Hiramatsu A, Iwamoto T, Kimura M, et al. Response criteria of tolvaptan for the treatment of hepatic edema. J Gastroenterol. 2018;53:258–68.PubMed
25.
Zurück zum Zitat Hiramine Y, Uto H, Mawatari S, et al. Effect of tolvaptan on the prognosis of patients with hepatic ascites. Hepatol Res. 2019;49:765–77.PubMed Hiramine Y, Uto H, Mawatari S, et al. Effect of tolvaptan on the prognosis of patients with hepatic ascites. Hepatol Res. 2019;49:765–77.PubMed
26.
Zurück zum Zitat Wong F, O'Leary JG, Reddy KR, et al. Acute kidney injury in cirrhosis: baseline serum creatinine predicts patient outcomes. Am J Gastroenterol. 2017;112:1103–10.PubMed Wong F, O'Leary JG, Reddy KR, et al. Acute kidney injury in cirrhosis: baseline serum creatinine predicts patient outcomes. Am J Gastroenterol. 2017;112:1103–10.PubMed
27.
Zurück zum Zitat Umemura T, Joshita S, Shibata S, et al. Renal impairment is associated with increased risk of mortality in patients with cirrhosis: a retrospective cohort study. Medicine (Baltimore). 2019;98:e14475. Umemura T, Joshita S, Shibata S, et al. Renal impairment is associated with increased risk of mortality in patients with cirrhosis: a retrospective cohort study. Medicine (Baltimore). 2019;98:e14475.
28.
Zurück zum Zitat Ginès P, Schrier RW. Renal failure in cirrhosis. N Engl J Med. 2009;361:1279–90.PubMed Ginès P, Schrier RW. Renal failure in cirrhosis. N Engl J Med. 2009;361:1279–90.PubMed
29.
Zurück zum Zitat Boyer TD, Warnock DG. Use of diuretics in the treatment of cirrhotic ascites. Gastroenterology. 1983;84(5 Pt 1):1051–5.PubMed Boyer TD, Warnock DG. Use of diuretics in the treatment of cirrhotic ascites. Gastroenterology. 1983;84(5 Pt 1):1051–5.PubMed
30.
Zurück zum Zitat Kanzaki G, Puelles VG, Cullen-McEwen LA, et al. New insights on glomerular hyperfiltration: a Japanese autopsy study. JCI Insight. 2017;2:94334.PubMed Kanzaki G, Puelles VG, Cullen-McEwen LA, et al. New insights on glomerular hyperfiltration: a Japanese autopsy study. JCI Insight. 2017;2:94334.PubMed
31.
Zurück zum Zitat Arroyo V, Ginès P, Gerbes AL, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Internat Ascites Club Hepatol. 1996;23:164–76. Arroyo V, Ginès P, Gerbes AL, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Internat Ascites Club Hepatol. 1996;23:164–76.
32.
Zurück zum Zitat Okabe T, Yakushiji T, Kido T, et al. The association between high-dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure. ESC Heart Fail. 2018;5:87–94.PubMed Okabe T, Yakushiji T, Kido T, et al. The association between high-dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure. ESC Heart Fail. 2018;5:87–94.PubMed
33.
Zurück zum Zitat Atsukawa M, Tsubota A, Takaguchi K, et al. Analysis of factors associated with the prognosis of cirrhotic patients who were treated with tolvaptan for hepatic edema. J Gastroenterol Hepatol. 2020;35:1229–377.PubMed Atsukawa M, Tsubota A, Takaguchi K, et al. Analysis of factors associated with the prognosis of cirrhotic patients who were treated with tolvaptan for hepatic edema. J Gastroenterol Hepatol. 2020;35:1229–377.PubMed
34.
Zurück zum Zitat Mehta RL, Pascual MT, Soroko S, et al. PICARD Study Group Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA. 2002;288:2547–53. Mehta RL, Pascual MT, Soroko S, et al. PICARD Study Group Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA. 2002;288:2547–53.
35.
Zurück zum Zitat Kapelios CJ, Kaldara E, Ntalianis A, et al. High furosemide dose has detrimental effects on survival of patients with stable heart failure. Hellenic J Cardiol. 2015;56:154–9.PubMed Kapelios CJ, Kaldara E, Ntalianis A, et al. High furosemide dose has detrimental effects on survival of patients with stable heart failure. Hellenic J Cardiol. 2015;56:154–9.PubMed
36.
Zurück zum Zitat Vaz NF, da Cunha VNR, Cunha-Silva M, et al. Evolution of diagnostic criteria for acute kidney injury in patients with decompensated cirrhosis: a prospective study in a tertiary university hospital. Clin Res Hepatol Gastroenterol. 2019;16:2210–7401. Vaz NF, da Cunha VNR, Cunha-Silva M, et al. Evolution of diagnostic criteria for acute kidney injury in patients with decompensated cirrhosis: a prospective study in a tertiary university hospital. Clin Res Hepatol Gastroenterol. 2019;16:2210–7401.
37.
Zurück zum Zitat Prowle JR, Echeverri JE, Ligabo EV, et al. Fluid balance and acute kidney injury. Nat Rev Nephrol. 2010;6:107–15.PubMed Prowle JR, Echeverri JE, Ligabo EV, et al. Fluid balance and acute kidney injury. Nat Rev Nephrol. 2010;6:107–15.PubMed
38.
Zurück zum Zitat Felker GM, Lee KL, Bull DA, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364:797–805.PubMedPubMedCentral Felker GM, Lee KL, Bull DA, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364:797–805.PubMedPubMedCentral
39.
Zurück zum Zitat Mori T, Ohsaki Y, Oba-Yabana I, et al. Diuretic usage for protection against end-organ damage in liver cirrhosis and heart failure. Hepatol Res. 2017;47:11–22.PubMed Mori T, Ohsaki Y, Oba-Yabana I, et al. Diuretic usage for protection against end-organ damage in liver cirrhosis and heart failure. Hepatol Res. 2017;47:11–22.PubMed
40.
Zurück zum Zitat Sersté T, Gustot T, Rautou PE, et al. Severe hyponatremia is a better predictor of mortality than MELDNa in patients with cirrhosis and refractory ascites. J Hepatol. 2012;57:274–80.PubMed Sersté T, Gustot T, Rautou PE, et al. Severe hyponatremia is a better predictor of mortality than MELDNa in patients with cirrhosis and refractory ascites. J Hepatol. 2012;57:274–80.PubMed
41.
Zurück zum Zitat Angeli P, Wong F, Watson H, et al. Hyponatremia in cirrhosis: Results of a patient population survey. Hepatology. 2006;44:1535–42.PubMed Angeli P, Wong F, Watson H, et al. Hyponatremia in cirrhosis: Results of a patient population survey. Hepatology. 2006;44:1535–42.PubMed
42.
Zurück zum Zitat Uojima H, Hidaka H, Nakayama T, et al. Efficacy of combination therapy with natriuretic and aquaretic drugs in cirrhotic ascites patients: a randomized study. World J Gastroenterol. 2017;23:8062–72.PubMedPubMedCentral Uojima H, Hidaka H, Nakayama T, et al. Efficacy of combination therapy with natriuretic and aquaretic drugs in cirrhotic ascites patients: a randomized study. World J Gastroenterol. 2017;23:8062–72.PubMedPubMedCentral
43.
Zurück zum Zitat Namba M, Hiramatsu A, Aikata H, et al. Management of refractory ascites attenuates muscle mass reduction and improves survival in patients with decompensated cirrhosis. J Gastroenterol. 2020;55:217–26.PubMed Namba M, Hiramatsu A, Aikata H, et al. Management of refractory ascites attenuates muscle mass reduction and improves survival in patients with decompensated cirrhosis. J Gastroenterol. 2020;55:217–26.PubMed
44.
Zurück zum Zitat Mindikoglu AL, Hernaez R, Liu Y, et al. Renal trajectory patterns are associated with post-discharge mortality in patients with cirrhosis and acute kidney injury. Clin Gastroenterol Hepatol. 2020;18:1858–66.PubMed Mindikoglu AL, Hernaez R, Liu Y, et al. Renal trajectory patterns are associated with post-discharge mortality in patients with cirrhosis and acute kidney injury. Clin Gastroenterol Hepatol. 2020;18:1858–66.PubMed
45.
Zurück zum Zitat Chawla LS, Eggers PW, Star RA, et al. Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med. 2014;371(1):58–66. Chawla LS, Eggers PW, Star RA, et al. Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med. 2014;371(1):58–66.
46.
Zurück zum Zitat Komiyama Y, Kurosaki M, Nakanishi H, Takahashi Y, Itakura J, Yasui Y, et al. Prediction of diuretic response to tolvaptan by a simple, readily available spot urine Na/K ratio. PLoS ONE. 2017;12:e0174649.PubMedPubMedCentral Komiyama Y, Kurosaki M, Nakanishi H, Takahashi Y, Itakura J, Yasui Y, et al. Prediction of diuretic response to tolvaptan by a simple, readily available spot urine Na/K ratio. PLoS ONE. 2017;12:e0174649.PubMedPubMedCentral
47.
Zurück zum Zitat Kudo M, Kitano M, Sakurai T, et al. General rules for the clinical and pathological study of primary liver cancer, nationwide follow-up survey and clinical practice guidelines: the outstanding achievements of the liver cancer study group of Japan. Dig Dis. 2015;33:765–70.PubMed Kudo M, Kitano M, Sakurai T, et al. General rules for the clinical and pathological study of primary liver cancer, nationwide follow-up survey and clinical practice guidelines: the outstanding achievements of the liver cancer study group of Japan. Dig Dis. 2015;33:765–70.PubMed
Metadaten
Titel
Impact of acute kidney injury on prognosis and the effect of tolvaptan in patients with hepatic ascites
verfasst von
Yasunari Hiramine
Hirofumi Uto
Seiichi Mawatari
Shuji Kanmura
Yasushi Imamura
Takuya Hiwaki
Akiko Saishoji
Manei Oku
Koichi Tokushige
Shigeho Maenohara
Akio Ido
Publikationsdatum
21.09.2020
Verlag
Springer Singapore
Erschienen in
Journal of Gastroenterology / Ausgabe 1/2021
Print ISSN: 0944-1174
Elektronische ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-020-01727-2

Weitere Artikel der Ausgabe 1/2021

Journal of Gastroenterology 1/2021 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.