title: Resistive index and MELD-Na: nephrologic monitoring in cirrhotic patients awaiting liver transplantation.
abstract: Renal dysfunction in cirrhotic patients is primarily related to disturbances in circulatory function. In decompensated cirrhosis, ascites and water retention are associated with development of dilutional hyponatremia. The arterial resistive index (RI) is a measure of resistance to arterial flow within the renal vascular bed. Hyponatremia is an independent predictor of mortality in patients with ascites. The aim of this study was to evaluate intrarenal RI in end-stage liver disease (ESLD) patients awaiting liver transplantation (LT) and its association with renal and hepatic function as assessed by Model for End-Stage Liver Disease (MELD) and MELD-Na scores. We evaluated 40 cirrhotic patients (23 males, 17 females) awaiting LT from January 2009 to January 2012. Twenty-six of the 40 patients (65%) showed a renal RI ≥ 0.70, the normal value according to standard reported evaluations. Patients with RI ≥ 0.70 showed significantly higher MELD and MELD-Na scores as well as greater higher serum creatinine and lower serum sodium concentrations compared with subject displaying RI <0.70. The most relevant result of our study was the strong association between elevated renal RI in ESLD patients and advanced liver dysfunction, as demonstrated by MELD and MELD-Na scores, hyponatremia, ascites, and acute renal failure episodes. In conclusion, this study suggested that intrarenal RI assessment should be considered in the clinical and nephrologic monitoring of cirrhotic patients awaiting LT.
authors.affiliation: Department of Clinical Medicine, Nephrology and Dialysis Unit, I Faculty of Medicine and Surgery, Sapienza University of Rome, Rome, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Umbro
authors.forename: F
authors.initials: F
authors.lastname: Tinti
authors.forename: F
authors.initials: F
authors.lastname: Fiacco
authors.forename: A
authors.initials: A
authors.lastname: Zavatto
authors.forename: P
authors.initials: P
authors.lastname: Piselli
authors.forename: V
authors.initials: V
authors.lastname: Di Natale
authors.forename: S
authors.initials: S
authors.lastname: Lai
authors.forename: A
authors.initials: A
authors.lastname: Vitarelli
authors.forename: S Ginanni
authors.initials: SG
authors.lastname: Corradini
authors.forename: M
authors.initials: M
authors.lastname: Rossi
authors.forename: L
authors.initials: L
authors.lastname: Poli
authors.forename: P B
authors.initials: PB
authors.lastname: Berloco
authors.forename: A P
authors.initials: AP
authors.lastname: Mitterhofer
mesh_terms: D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic