title: Incidence and risk factors for acute renal failure in patients with hepatocellular carcinoma undergoing transarterial chemoembolization: a prospective study.
abstract: BACKGROUND
  Transarterial chemoembolization (TACE) is effective for hepatocellular carcinoma (HCC). Considerable amounts of radiocontrast agent are used for TACE and may induce renal dysfunction.
  
  
  METHODS
  This study prospectively investigated the incidence and risk factors of acute renal failure (ARF), defined as an increase of serum creatinine level >1.5 mg/dl after TACE.
  
  
  RESULTS
  ARF developed in 12 (8.6%) of 140 patients after TACE. Univariate analysis showed that number of treatment sessions (2.3 +/- 1.4 vs 1.3 +/- 1.6, P=0.013), Child-Pugh class B (50% vs 21%, P=0.035) and the occurrence of severe postembolization syndrome (75% vs 30%, P=0.020) were significantly associated with the development of ARF. Multivariate logistic regression analysis disclosed that the proportional increased risk of ARF was 65% for each additional TACE therapy (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.13-2.41, P=0.010). Other independent risk factors were Child-Pugh class B (OR: 12.82, 95% CI: 2.44-67.29, P=0.003) and severe postembolization syndrome (OR: 6.64, 95% CI: 1.60-27.49, P=0.009). Four (33%) of the patients with ARF developed irreversible renal function impairment, and diabetes mellitus was the only associated factor (P=0.067) in this group.
  
  
  CONCLUSIONS
  ARF after TACE is closely associated with number of treatment sessions, severity of cirrhosis and development of severe postembolization syndrome. Effective preventive measures should be undertaken especially in high-risk patients.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China. tihuo@vghtpe.gov.tw
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.forename: Jaw-Ching
authors.initials: JC
authors.lastname: Wu
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.forename: Full-Young
authors.initials: FY
authors.lastname: Chang
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology* / Q000503:physiopathology; D000368:Aged; D001158:Arteries; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index