title: Acute renal failure after transarterial chemoembolization for hepatocellular carcinoma: a retrospective study of the incidence, risk factors, clinical course and long-term outcome.
abstract: BACKGROUND
  Transarterial chemoembolization is effective for hepatocellular carcinoma. Acute renal failure may occur after transarterial chemoembolization because of radiocontrast agent, but its clinical aspects are unknown.
  
  
  OBJECTIVE
  To investigate the incidence, risk factors and outcome of acute renal failure, defined as increase of serum creatinine > 1.5 mg/dL, after transarterial chemoembolization.
  
  
  METHODS
  A total of 235 hepatocellular carcinoma patients with 843 transarterial chemoembolization treatment sessions were analysed.
  
  
  RESULTS
  Acute renal failure developed in 56 (23.8%) patients and the estimated risk of developing acute renal failure was 6.6% in each treatment session. Comparison between the episodes of transarterial chemoembolization with and without acute renal failure by using the generalized estimating equation disclosed that Child-Pugh class B (odds ratio: 2.6, P = 0.007) and treatment session (odds ratio: 1.3; P < 0.0001) were independent risk factors of acute renal failure. Twenty-seven patients had prolonged renal function impairment. Multivariate analysis by generalized estimating equation showed that Child-Pugh class B (odds ratio: 4.3, P = 0.0004) and diabetes mellitus (odds ratio: 5.2, P < 0.0001) were linked with prolonged acute renal failure, which independently predicted a decreased survival (relative risk: 2.3, P = 0.002).
  
  
  CONCLUSIONS
  Acute renal failure after transarterial chemoembolization appears to be dose-related and is associated with the severity of cirrhosis. Patients with diabetes mellitus or Child-Pugh class B more frequently develop prolonged acute renal failure, which in turn is a poor prognostic predictor.
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan. tihuo@vghtpe.gov.tw
authors.forename: T-I
authors.initials: TI
authors.lastname: Huo
authors.forename: J-C
authors.initials: JC
authors.lastname: Wu
authors.forename: Y-H
authors.initials: YH
authors.lastname: Huang
authors.forename: J-H
authors.initials: JH
authors.lastname: Chiang
authors.forename: P-C
authors.initials: PC
authors.lastname: Lee
authors.forename: F-Y
authors.initials: FY
authors.lastname: Chang
authors.forename: S-D
authors.initials: SD
authors.lastname: Lee
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome