title: Renal failure in patients with end stage liver disease and its impact on clinical outcome.
abstract: OBJECTIVE
  To evaluate the prevalence of renal failure (RF) in the patients of end stage liver disease (ESLD), to determine the causes of RF in these patients and its impact on patient's outcome.
  
  
  METHODS
  Descriptive, analytical study.
  
  
  METHODS
  Shifa International Hospital, Islamabad, Pakistan, from May 2011 to March 2013.
  
  
  METHODS
  A total of 523 patients with end stage liver disease (ESLD) were evaluated, renal failure (RF) and its causes were recognized in these patients according to established criteria. Outcome of these patients was assigned as reversal of RF or mortality. Data was analyzed using SPSS version 16. Chi-square test was used for comparing proportions and t-test was used for comparing mean values. P < 0.05 was considered significant.
  
  
  RESULTS
  Out of 523 patients, 261 (49.9%) had RF. Acute kidney injury (AKI) was the most common presentation seen in 160 (61%) patients. Hypovolemia and infections were the most frequent causes of RF. Mortality was significantly higher in the patients with RF, when compared to the patients without RF (31% vs. 4.5%, p < 0.001). Reversal of RF was seen in 98 (37%) of the affected patients. Reversal was more common in the patients with hypovolemia. The mortality was higher in the patients with hepatorenal syndrome (HRS) and infections.
  
  
  CONCLUSIONS
  Renal failure in the end stage liver disease is an important prognostic factor. Etiology of RF is the key factor in patients' outcome. Patients of ESLD with RF had higher mortality. Majority of the cases of RF were reversible in patients of ESLD coming in the setup.
authors.affiliation: Department of Gastroenterology, Shifa International Hospital, Islamabad.
authors.forename: Muhammad Omar
authors.initials: MO
authors.lastname: Qureshi
authors.affiliation: Department of Gastroenterology, Shifa International Hospital, Islamabad.
authors.forename: Farzana
authors.initials: F
authors.lastname: Shafqat
authors.affiliation: Department of Gastroenterology, Shifa International Hospital, Islamabad.
authors.forename: Faisal Saud
authors.initials: FS
authors.lastname: Dar
authors.affiliation: Department of Gastroenterology, Shifa International Hospital, Islamabad.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Salih
authors.affiliation: Department of Gastroenterology, Shifa International Hospital, Islamabad.
authors.forename: Nasir
authors.initials: N
authors.lastname: Khokhar
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005260:Female; D006530:Hepatorenal Syndrome / Q000453:epidemiology; D006801:Humans; D020896:Hypovolemia / Q000453:epidemiology / Q000209:etiology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality