Effect of transcatheter arterial chemoembolization on kidney hemodynamics and function in patients with cirrhosis and hepatocellular carcinoma.
OBJECTIVE
Transcatheter arterial chemoembolization (TACE) may have deleterious effect on the kidney in patients with cirrhosis and hepatocellular carcinoma. The aim of the study was to test this hypothesis.


METHODS
Twenty-four patients with cirrhosis and hepatocellular carcinomas were included. They consisted of 16 patients undergoing a single TACE and eight patients undergoing diagnostic angiography. Doppler ultrasonography was used to measure hepatic artery pulsatility index (HA-PI) and renal artery pulsatility index (RA-PI) before and 1 day and 10 days after the procedure. Similarly, kidney function was assessed by measuring creatinine clearance. In addition, plasma renin activity, noradrenaline, and endothelin-1 were also measured.


RESULTS
In patients receiving diagnostic angiography, no significant changes in HA-PI were observed after the procedure. In contrast, HA-PI increased significantly 1 day after the procedure (19%, p<0.01) in patients undergoing TACE, although it returned to baseline value 10 days after the procedure. In patients undergoing diagnostic angiography, no significant changes in RA-PI were observed after the procedure. Similarly, no detectable changes in RA-PI were noted in patients undergoing TACE. A transient small reduction in creatinine clearance was noted after the procedure in patients undergoing diagnostic angiography (-12%, p<0.05) and in those undergoing TACE (-11%, p<0.05). However, the effect was similar in the two groups (two-way ANOVA, p=0.72). No significant changes in plasma renin activity, noradrenaline, and endothelin-1 were observed after either diagnostic angiography or TACE.


CONCLUSIONS
These results suggest that TACE per se has no deleterious effect on the kidney hemodynamics and function in patients with cirrhosis and hepatocellular carcinoma.
Nakano
R
R
Second Department of Medicine, Kurume University School of Medicine, Japan. iwao@toq.or.jp
Iwao
T
T
Oho
K
K
Ono
N
N
Sakai
T
T
Sato
M
M
Yamawaki
M
M
Miyamoto
Y
Y
Sakai
K
K
Takeda
T
T
Tsuruta
O
O
Sata
M
M
Toyonaga
A
A
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000009:adverse effects; D001783:Blood Flow Velocity; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002408:Catheters, Indwelling; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D003404:Creatinine / Q000097:blood; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007269:Injections, Intra-Arterial; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow; D012077:Renal Artery / Q000000981:diagnostic imaging; D012079:Renal Circulation; D018608:Ultrasonography, Doppler
D003404:Creatinine