title: Changes in Kidney Function After Transjugular Intrahepatic Portosystemic Shunts Versus Large-Volume Paracentesis in Cirrhosis: A Matched Cohort Analysis.
abstract: BACKGROUND
  Patients with cirrhosis and refractory ascites have physiologic and hormonal dysregulation that contributes to decreased kidney function. Placement of a transjugular intrahepatic portosystemic shunt (TIPS) can reverse these changes and potentially improve kidney function. We sought to evaluate change in estimated glomerular filtration rate (eGFR) following TIPS placement.
  
  
  METHODS
  Retrospective, matched cohort analysis.
  
  
  METHODS
  Patients who underwent first-time TIPS placement for refractory ascites in 1995 to 2014. Frequency matching was used to generate a comparator group of patients with cirrhosis and ascites treated with serial large-volume paracentesis (LVP) in a 1:1 fashion.
  
  
  METHODS
  TIPS placement compared to serial LVP.
  
  
  RESULTS
  Change in eGFR over 90 days' follow-up.
  
  
  METHODS
  Multivariable regression stratified by baseline eGFR<60 versus ≥60mL/min/1.73m(2); analysis of effect modification between TIPS placement and baseline eGFR.
  
  
  RESULTS
  276 participants (TIPS, n=138; serial LVP, n=138) were analyzed. After 90 days, eGFRs increased significantly after TIPS placement in participants with baseline eGFRs<60mL/min/1.73m(2) compared to treatment with serial LVP (21 [95% CI, 13-29] mL/min/1.73m(2); P<0.001) and was no different in those with eGFRs≥60mL/min/1.73m(2) (1 [95% CI, -9 to 12] mL/min/1.73m(2); P=0.8). There was significant effect modification between TIPS status and baseline eGFR (P=0.001) in a model that included all participants.
  
  
  CONCLUSIONS
  Outcomes restricted by clinically recorded data; clinically important differences may still exist between the TIPS and LVP cohorts despite good statistical matching.
  
  
  CONCLUSIONS
  TIPS placement was associated with significant improvement in kidney function. This was most prominent in participants with baseline eGFRs<60mL/min/1.73m(2). Prospective studies of TIPS use in populations with eGFRs<60mL/min/1.73m(2) are needed to evaluate these findings.
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA. Electronic address: aallegretti@partners.org.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Allegretti
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ortiz
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Jie
authors.initials: J
authors.lastname: Cui
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Julia
authors.initials: J
authors.lastname: Wenger
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Ishir
authors.initials: I
authors.lastname: Bhan
authors.affiliation: Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Chung
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Ravi I
authors.initials: RI
authors.lastname: Thadhani
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA.
authors.forename: Zubin
authors.initials: Z
authors.lastname: Irani
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012189:Retrospective Studies; D013997:Time Factors
keywords: TIPS placement; Transjugular intrahepatic portosystemic shunt (TIPS); cirrhosis; estimated glomerular filtration rate (eGFR); kidney; large-volume paracentesis (LVP); liver; mortality; portal hypertension; refractory ascites; renal function