Renal failure in patients with hepatocellular carcinoma and ascites undergoing transarterial chemoembolization.
BACKGROUND
Ascites is often present in patients with hepatocellular carcinoma (HCC) with cirrhosis. Advanced cirrhosis may predispose to renal dysfunction. Acute renal failure (ARF) may occur after transarterial chemoembolization (TACE) for HCC because of radiocontrast agents. This study aimed to investigate the incidence and risk factors of ARF and prognostic predictors in HCC patients with ascites undergoing TACE.


METHODS
A total of 591 HCC patients receiving TACE were enrolled.


RESULTS
In a mean follow-up duration of 19+/-17 months, 239 (40.4%) patients undergoing TACE died. Ascites, which was present in 91 (15.4%) patients at entry, independently predicted a poor prognosis in the Cox proportional hazard model [risk ratio (RR): 1.71, P=0.002]. Of these, 11 (12.6%) of 87 patients with complete follow-up developed ARF after TACE. Serum albumin level <3.3 g/dl (odds ratio: 7.3, P=0.009) was the only independent risk factor associated with ARF in the logistic regression analysis. ARF (RR: 2.17, P=0.036), alpha-fetoprotein >400 ng/ml (RR: 1.84, P=0.04), multiple tumours (RR: 2.11, P=0.013), tumour size > or = 5 cm (RR: 2.32, P=0.006) and serum sodium level <139 mmol/L (RR: 2.4, P=0.005) were independent poor prognostic predictors for HCC patients with ascites receiving TACE.


CONCLUSIONS
Pre-existing ascites is associated with increased mortality in HCC patients receiving TACE. In HCC patients with ascites, hypoalbuminaemia is associated with the occurrence of post-TACE ARF. Post-TACE ARF is a poor prognostic predictor in this subset of HCC patients.
Hsu
Chia-Yang
CY
Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Huang
Yi-Hsiang
YH
Su
Chien-Wei
CW
Lin
Han-Chieh
HC
Chiang
Jen-Huey
JH
Lee
Pui-Ching
PC
Lee
Fa-Yauh
FY
Huo
Teh-Ia
TI
Lee
Shou-Dong
SD
D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001201:Ascites / Q000473:pathology*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D015897:Comorbidity; D005260:Female; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology
D000970:Antineoplastic Agents