title: Incidence, risk factors, and prognosis of acute kidney injury following transarterial chemoembolization in patients with hepatocellular carcinoma: a prospective cohort study.
abstract: BACKGROUND
  Transcatheter arterial chemoembolization (TACE) is an effective first-line therapy for intermediate stage hepatocellular carcinoma (HCC). Acute renal injury may be induced after transarterial chemoembolization because of iodinated radiocontrast medium, but its incidence, risk factors, and prognosis remain unclear.
  
  
  METHODS
  This prospective study enrolled 166 HCC patients with a total of 316 TACE treatments. The incidence, risk factors, and prognosis of acute kidney injury (AKI) were examined.
  
  
  RESULTS
  The incidence of post-TACE AKI was 21.84% (69/316) according to Barrett and Parfrey criteria, whereas 7.59% (24/316) according to acute kidney injury network (AKIN) criteria. Multivariate logistic regression analysis showed that serum total bilirubin (TB) (>13.5 μmol/L; odds ratio [OR]: 1.871 95% confidence interval [CI]: 1.044-3.352; P = 0.035) and hemoglobin (HGB) level (<120 g/L; OR: 1.823, 95% CI: 1.019-3.264; P = 0.043) were associated with the development of AKI after TACE procedure in accordance to Barrett and Parfrey criteria. Meanwhile, age (>55 years; OR: 3.456, 95% CI: 1.107-10.790; P = 0.033), post-TACE AKI history (OR: 7.108, 95% CI: 1.387-36.434, P = 0.019), and serum aminotransferase level (>55 U/L; OR: 4.420, 95% CI: 1.792-10.906; P = 0.001) were associated with the development of AKI after TACE procedure in accordance to AKIN criteria. Total hospitalization cost was significantly higher (P = 0.034) in the patients with AKI after TACE procedure according to Barrett and Parfrey criteria. A post-TACE AKI diagnosis was associated with mortality in any definition used (P = 0.034 and P = 0.001 for Barrett and Parfrey and AKIN criteria, respectively).
  
  
  CONCLUSIONS
  The present study showed that the incidence of post-TACE AKI was high in HCC patients (i.e., 7.59-21.84%) depending on criteria used. HGB (<120 g/L), serum TB (>13.5), and aminotransferase level (>55 U/L), age (>55 years) and post-TACE AKI history may be predictors of post-TACE AKI in HCC patients. The development of post-TACE AKI was associated with the risk of renal replacement treatment, prolonged renal insufficiency, or mortality according to AKIN criteria.
authors.forename: J F
authors.initials: JF
authors.lastname: Hao
authors.forename: L W
authors.initials: LW
authors.lastname: Zhang
authors.forename: J X
authors.initials: JX
authors.lastname: Bai
authors.forename: Y J
authors.initials: YJ
authors.lastname: Li
authors.forename: J N
authors.initials: JN
authors.lastname: Liu
authors.forename: X L
authors.initials: XL
authors.lastname: Zhang
authors.forename: J M
authors.initials: JM
authors.lastname: Han
authors.forename: X
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Interventional Radiology, General Hospital of Shenyang Military Area Command, Shenyang 110000, China.
authors.forename: H
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Blood Purification, General Hospital of Shenyang Military Area Command, Shenyang 110000, China.
authors.forename: N
authors.initials: N
authors.lastname: Cao
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D002681:China / Q000453:epidemiology; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate