Sophie McAllister1, Jennifer C Lai2, Timothy P Copeland3, Kirsten L Johansen4, Charles E McCulloch5, Yuenting D Kwong3, Divya Seth3,6, Barbara Grimes5, Elaine Ku3,5,6. 1. School of Medicine, University of California San Francisco, San Francisco, California. 2. Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California. 3. Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California. 4. Division of Nephrology, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota. 5. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California. 6. Division of Pediatric Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, California.
Abstract
Background: Kidney replacement therapy is controversial for patients with hepatorenal syndrome who may not be liver transplant candidates. Data surrounding the likelihood of recovery of kidney function and mortality after outpatient dialysis initiation in patients with dialysis-requiring hepatorenal syndrome could inform discussions between patients and providers. Methods: We performed a retrospective cohort study of patients with hepatorenal syndrome who were registered in the United States Renal Data System between 1996 and 2015 (n=7830) as receiving maintenance dialysis. We characterized patients with hepatorenal syndrome by recovery of kidney function using Fine and Gray models. We also examined hazard of recovery of kidney function and death among those with hepatorenal syndrome versus those with acute tubular necrosis (n=48,861) using adjusted Fine-Gray and Cox models, respectively. Results: Of the patients with hepatorenal syndrome, 11% recovered kidney function. Those with higher likelihood of recovery were younger, non-Hispanic White, and had a history of alcohol use. Compared with patients with acute tubular necrosis, patients with hepatorenal syndrome as the attributed cause of kidney disease had a lower hazard of recovery (HR, 0.22; 95% CI, 0.21 to 0.24) and higher hazard of death within 1 year (HR, 3.10; 95% CI, 2.99 to 3.23) in fully adjusted models. Conclusions: Patients with hepatorenal syndrome receiving chronic maintenance dialysis had a lower likelihood of recovery of kidney function and higher mortality risk compared with patients with acute tubular necrosis. Among patients with hepatorenal syndrome, those most likely to recover kidney function were younger, had a history of alcohol use, and lacked comorbid conditions. These data may inform prognosis and discussions surrounding treatment options when patients with hepatorenal syndrome need chronic maintenance dialysis therapy.
Background: Kidney replacement therapy is controversial for patients with hepatorenal syndrome who may not be liver transplant candidates. Data surrounding the likelihood of recovery of kidney function and mortality after outpatient dialysis initiation in patients with dialysis-requiring hepatorenal syndrome could inform discussions between patients and providers. Methods: We performed a retrospective cohort study of patients with hepatorenal syndrome who were registered in the United States Renal Data System between 1996 and 2015 (n=7830) as receiving maintenance dialysis. We characterized patients with hepatorenal syndrome by recovery of kidney function using Fine and Gray models. We also examined hazard of recovery of kidney function and death among those with hepatorenal syndrome versus those with acute tubular necrosis (n=48,861) using adjusted Fine-Gray and Cox models, respectively. Results: Of the patients with hepatorenal syndrome, 11% recovered kidney function. Those with higher likelihood of recovery were younger, non-Hispanic White, and had a history of alcohol use. Compared with patients with acute tubular necrosis, patients with hepatorenal syndrome as the attributed cause of kidney disease had a lower hazard of recovery (HR, 0.22; 95% CI, 0.21 to 0.24) and higher hazard of death within 1 year (HR, 3.10; 95% CI, 2.99 to 3.23) in fully adjusted models. Conclusions: Patients with hepatorenal syndrome receiving chronic maintenance dialysis had a lower likelihood of recovery of kidney function and higher mortality risk compared with patients with acute tubular necrosis. Among patients with hepatorenal syndrome, those most likely to recover kidney function were younger, had a history of alcohol use, and lacked comorbid conditions. These data may inform prognosis and discussions surrounding treatment options when patients with hepatorenal syndrome need chronic maintenance dialysis therapy.
Authors: Katharina Staufer; Kevin Roedl; Danijel Kivaranovic; Andreas Drolz; Thomas Horvatits; Susanne Rasoul-Rockenschaub; Christian Zauner; Michael Trauner; Valentin Fuhrmann Journal: Liver Int Date: 2017-04-05 Impact factor: 5.828
Authors: Andrew S Allegretti; Xavier Vela Parada; Nwamaka D Eneanya; Hannah Gilligan; Dihua Xu; Sophia Zhao; Jules L Dienstag; Raymond T Chung; Ravi I Thadhani Journal: Clin J Am Soc Nephrol Date: 2017-11-09 Impact factor: 8.237
Authors: Edmund Q Sanchez; Thomas A Gonwa; Marlon F Levy; Robert M Goldstein; Martin L Mai; Steven R Hays; Larry B Melton; Giovanna Saracino; Goran B Klintmalm Journal: Transplantation Date: 2004-10-15 Impact factor: 4.939