title: Frequency, pattern and short-term outcome of chronic renal dysfunction in patients with cirrhosis: a prospective study using HRS and ADQI-IAC criteria.
abstract: BACKGROUND
  Diagnostic criteria of hepatorenal syndrome type 2 (HRS2) fail to detect milder degrees of chronic renal dysfunction (CRD) in cirrhosis and exclude patients with pre-existing kidney disease. Definitions addressing this have been proposed by Working Party of the Acute Dialysis Quality Initiative and International Ascites Club (ADQI-IAC).
  
  
  OBJECTIVE
  We studied the frequency, pattern and short-term outcome of CRD in patients with cirrhosis, using both HRS2 and ADQI-IAC criteria.
  
  
  METHODS
  Consecutive patients with cirrhosis and stable serum creatinine for 3 months or more attending outpatient clinics in Colombo North Teaching Hospital (Ragama, Sri Lanka) were prospectively recruited and followed up.
  
  
  RESULTS
  Of 277 patients with cirrhosis and stable serum creatinine, 23 (8.3%) fulfilled criteria for HRS2, and 65/277 (23.5%) had estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m [ADQI-IAC definition of chronic kidney disease (CKD)]. This included the 23 patients with HRS2 and an additional 42/65 (64.6%) who did not fulfil diagnostic criteria for HRS2 (non-HRS2 CKD). In all, 58/277 (20.9%) died during follow-up [mean 9.8 months (SD 4.5)]. This included 12/23 (52.2%) with HRS2 and 14/42 (33.3%) with non-HRS2 CKD. On the basis of multiple regression model, Child-Turcotte-Pugh class and CRD were significantly associated with death. After correcting for Child-Turcotte-Pugh class, both HRS2 (odds ratio 4.56, 95% confidence interval 1.79-11.53) and non-HRS2 CKD (odds ratio 2.19, 95% confidence interval 1.02-4.68) were independently associated with death.
  
  
  CONCLUSIONS
  Compared with HRS2 criteria, eGFR less than 60 ml/min/1.73 m detected almost twice the number of cirrhotics with CRD. Patients with eGFR less than 60 ml/min/1.73 m who did not fulfil criteria for HRS2 also had significant short-term mortality. ADQI-IAC criteria thus appear to be a more useful definition of CRD in cirrhotics.
authors.affiliation: aUniversity Medical Unit, Colombo North Teaching Hospital Departments of bMedicine cPublic Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Shamila T
authors.initials: ST
authors.lastname: De Silva
authors.forename: Ruwan P
authors.initials: RP
authors.lastname: Perera
authors.forename: Madunil A
authors.initials: MA
authors.lastname: Niriella
authors.forename: Arunasalam
authors.initials: A
authors.lastname: Pathmeswaran
authors.forename: Hithanadura Janaka
authors.initials: HJ
authors.lastname: de Silva
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006530:Hepatorenal Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D003404:Creatinine