[Incidence and risk factors of acute renal failure after transcatheter arterial chemoembolization for hepatocellular carcinoma].
OBJECTIVE
Transcatheter arterial chemoembolization (TACE) is a major modality in the treatment of unresectable hepatocellular carcinoma. Acute renal failure (ARF) may occur after TACE because of underlying liver cirrhosis and the presence of radiocontrast agent. However, the data available regarding this complication are variable and limited. The aim of this study was to determine the incidence and associated risk factors of ARF after TACE.


METHODS
From January 2001 to December 2004, a total of 632 procedures were performed in 377 patients. Of these, the cases with high creatinine levels (> or = 2 mg/dL) before TACE and with incomplete medical records were excluded, which resulted in 463 procedures in 319 patients (256 males and 63 females; age 58.7+/-9.9 years, mean+/-SD) being examined for this study. Various clinical and radiological data before and after the procedure were reviewed retrospectively.


RESULTS
ARF occurred following 15 (3.2%) of the 463 procedures within 7 days of TACE. Univariate analysis revealed that serum albumin levels (P=0.025), Model for End-Stage Liver Disease score (P=0.001), the distribution of Child-Pugh class (P=0.027), and the proportions of patients with ascites (P<0.001), using diuretics (P=0.010), and with a serum creatinine level > or = 1.5 mg/dL (P=0.023) differed significantly between patients with or without ARF after TACE. In multivariate analysis, the presence of ascites (P=0.005; odds ratio, 5.297) and serum creatinine level > or = 1.5 mg/dL (P=0.007; odds ratio, 7.358) were independently associated with the development of ARF.


CONCLUSIONS
The incidence of ARF after TACE was 3.2%, and the presence of ascites and an abnormal baseline serum creatinine level were the risk factors for ARF.
Jang
Byoung Kuk
BK
Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Korea.
Lee
Seung Hyun
SH
Chung
Woo Jin
WJ
Park
Kyung Sik
KS
Cho
Kwang Bum
KB
Hwang
Jae Seok
JS
Kim
Young Hwan
YH
Choi
Jin Soo
JS
Kwon
Jung Hyeok
JH
D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects* / Q000401:mortality; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis
D003404:Creatinine