title: Causes of renal failure in patients with decompensated cirrhosis and its impact in hospital mortality.
abstract: BACKGROUND
  Renal failure (RF) is reported to occur in 11-49% of the patients with decompensated end-stage liver disease (ESLD) and has been associated with increased mortality, particularly in the occurrence of hepatorenal syndrome (HRS) type 1.
  
  
  OBJECTIVE
  To evaluate the frequency and outcome of RF in patients admitted to the hospital due to decompensated ESLD and to assess the impact of the underlying cause of RF on survival.
  
  
  METHODS
  Four hundred and six patients (65% males, mean age 62 ± 12 years) with decompensated ESLD were evaluated for the occurrence of RF (defined as serum creatinine ³ 1.5 mg/mL). The underlying cause of RF was reckoned in each subject and compared to outcome.
  
  
  RESULTS
  Renal failure was observed in 39% of the patients at admission and in 10% of the subjects during hospitalization. Mortality was significantly higher in subjects with RF (26 vs. 1%, p < 0.000001). Hypovolemia, bacterial infections, parenchymal kidney diseases and HRS were identified as causes of RF in, respectively, 40, 32, 15 and 12% of the cases. Mortality was significantly higher in those subjects with HRS type 1 and bacterial infections, when compared to other causes of RF.
  
  
  CONCLUSIONS
  Renal failure occurs in nearly half of the patients with decompensated ESLD. It is most commonly caused by hypovolemia and bacterial infections. Occurrence of RF has an adverse impact in patient survival, particularly in those subjects with bacterial infections and HRS type 1, prone to develop progressive renal dysfunction despite intensive medical care.
authors.affiliation: Unit of Gastroenterology and Hepatology of the Portuguese Hospital of Salvador, Bahia, Brazil.
authors.forename: Grazielle Cerqueira de
authors.initials: GC
authors.lastname: Carvalho
authors.forename: Catarina de Andrade
authors.initials: Cde A
authors.lastname: Regis
authors.forename: Jamile Rosário
authors.initials: JR
authors.lastname: Kalil
authors.forename: Liv Aparício
authors.initials: LA
authors.lastname: Cerqueira
authors.forename: Daniel Silva
authors.initials: DS
authors.lastname: Barbosa
authors.forename: Marina Pamponet
authors.initials: MP
authors.lastname: Motta
authors.forename: Marília
authors.initials: M
authors.lastname: da Silva Nery
authors.forename: Maria Alice
authors.initials: MA
authors.lastname: Pires Soares
authors.forename: Claudio Celestino
authors.initials: CC
authors.lastname: Zollinger
authors.forename: Paulo Lisboa
authors.initials: PL
authors.lastname: Bittencourt
mesh_terms: D000367:Age Factors; D000368:Aged; D001424:Bacterial Infections / Q000150:complications; D015897:Comorbidity; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D006530:Hepatorenal Syndrome / Q000150:complications; D017052:Hospital Mortality; D006801:Humans; D020896:Hypovolemia / Q000150:complications; D007674:Kidney Diseases / Q000150:complications; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D015996:Survival Rate