Chiara Elia1, Isabel Graupera2, Rogelio Barreto1, Elsa Solà1, Rebeca Moreira1, Patricia Huelin1, Xavier Ariza1, Cristina Solé1, Elisa Pose1, Anna Baiges1, Núria Fabrellas3, Esteban Poch4, Javier Fernández1, Vicente Arroyo1, Pere Ginès1. 1. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Spain. 2. Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Spain. Electronic address: igraupe@clinic.ub.es. 3. Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; School of Nursing, University of Barcelona, Spain. 4. Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Nephrology Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.
Abstract
BACKGROUND & AIMS: Non-steroidal anti-inflammatory drugs (NSAIDs) may cause impairment of kidney function in patients with cirrhosis. Investigational studies demonstrated reversibility of kidney dysfunction after drug withdrawal, but information based on clinical practice is lacking. The aim of the study was to investigate the characteristics and outcome of Acute Kidney Injury (AKI) developing in patients with cirrhosis treated with NSAIDs. METHODS: Prospective cohort study in a tertiary referral center of all patients with NSAIDs-associated AKI seen from 2002 to 2014. For comparison, three control groups of patients with hypovolemic-induced AKI, type-1 HRS and ATN, respectively, were also evaluated. Urinary excretion of neutrophil gelatinase-associated lipocalin (uNGAL) was measured in a subset of patients. RESULTS: Thirty patients with cirrhosis and NSAIDs-associated AKI were identified. In 19 patients (63%) AKI was transient and kidney function rapidly recovered (4±3 days) after NSAIDs withdrawal. In the remaining 11 patients (37%) AKI was more severe and persisted during hospitalization despite drug withdrawal. Patients with persistent AKI had remarkably higher uNGAL levels compared with those of patients with transient AKI (953±1,198 vs. 83±79 μg/g of creatinine, respectively, p=0.008). Moreover, seven of the 11 patients with persistent AKI (64%) died within three months compared with only one of the 19 (5%) patients with transient AKI (p=0.001). Mortality of persistent AKI was similar in NSAIDs patients compared to control groups. The only independent predictive factor of three-month mortality was persistent AKI. CONCLUSIONS: Patients with cirrhosis treated with NSAIDs may develop severe AKI which may be irreversible and associated with poor short-term outcome.
BACKGROUND & AIMS: Non-steroidal anti-inflammatory drugs (NSAIDs) may cause impairment of kidney function in patients with cirrhosis. Investigational studies demonstrated reversibility of kidney dysfunction after drug withdrawal, but information based on clinical practice is lacking. The aim of the study was to investigate the characteristics and outcome of Acute Kidney Injury (AKI) developing in patients with cirrhosis treated with NSAIDs. METHODS: Prospective cohort study in a tertiary referral center of all patients with NSAIDs-associated AKI seen from 2002 to 2014. For comparison, three control groups of patients with hypovolemic-induced AKI, type-1 HRS and ATN, respectively, were also evaluated. Urinary excretion of neutrophil gelatinase-associated lipocalin (uNGAL) was measured in a subset of patients. RESULTS: Thirty patients with cirrhosis and NSAIDs-associated AKI were identified. In 19 patients (63%) AKI was transient and kidney function rapidly recovered (4±3 days) after NSAIDs withdrawal. In the remaining 11 patients (37%) AKI was more severe and persisted during hospitalization despite drug withdrawal. Patients with persistent AKI had remarkably higher uNGAL levels compared with those of patients with transient AKI (953±1,198 vs. 83±79 μg/g of creatinine, respectively, p=0.008). Moreover, seven of the 11 patients with persistent AKI (64%) died within three months compared with only one of the 19 (5%) patients with transient AKI (p=0.001). Mortality of persistent AKI was similar in NSAIDs patients compared to control groups. The only independent predictive factor of three-month mortality was persistent AKI. CONCLUSIONS:Patients with cirrhosis treated with NSAIDs may develop severe AKI which may be irreversible and associated with poor short-term outcome.
Authors: Jessica B Rubin; Jennifer C Lai; Amy M Shui; Samuel F Hohmann; Andrew Auerbach Journal: J Clin Gastroenterol Date: 2021-10-14 Impact factor: 3.062
Authors: Lisa A Majuta; Jean-Marc G Guedon; Stefanie A T Mitchell; Michael H Ossipov; Patrick W Mantyh Journal: Pain Date: 2017-04 Impact factor: 7.926
Authors: Kelly L Hayward; Preya J Patel; Patricia C Valery; Leigh U Horsfall; Catherine Y Li; Penny L Wright; Caroline J Tallis; Katherine A Stuart; Katharine M Irvine; W Neil Cottrell; Jennifer H Martin; Elizabeth E Powell Journal: Hepatol Commun Date: 2019-03-18