Predicting the development of acute kidney injury in liver cirrhosis: an analysis of glomerular filtration rate, proteinuria and kidney injury biomarkers

A. J. Slack, M. J. W. McPhail, Marlies Ostermann, M. Bruce, Roy Sherwood, R. Musto, T. Dew, G. Auzinger, W. Bernal, John O'Grady, M. A. Heneghan, K. Moore, J. A. Wendon*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Citations (Scopus)

Abstract

Background
The timely diagnosis of acute kidney injury (AKI) in liver cirrhosis is challenging.

Aim
To evaluate whether quantification of glomerular filtration rate (GFR), proteinuria and kidney injury biomarkers can accurately predict the development of AKI.

Methods
A prospective cohort analysis of patients with cirrhosis was performed. Measures of baseline kidney function included serum creatinine, iohexol clearance and urine protein:creatinine ratio. Blood and urine samples were collected daily. A retrospective analysis of cystatin C GFR and neutrophil gelatinase-associated lipocalin (NGAL) measured 48 h prior to the diagnosis of AKI was undertaken to evaluate their ability to predict the development of AKI.

Results
Eighteen of the 34 cirrhosis patients studied developed AKI. A GFR <60 mL/min/1.73 m2 was identified in 56% with Iohexol clearance compared to 8% using the four-variable modified diet in renal disease formula (P < 0.0001). Prediction of AKI, 48 h prior to the development of AKI with cystatin C GFR and serum NGAL concentration were similar; area under the receiver operating curve (AUROC) values 0.74 (0.51–0.97), P = 0.04 and 0.72 (0.52–0.92), P = 0.02 respectively. The development of AKI was strongly predicted by urine protein:creatinine ratio above the cut-off of >30 (equivalent to 300 mg/day of proteinuria) sensitivity 82% (57–96) and specificity 80% (52–96), AUROC 0.86 (0.73–0.98), P ≤ 0.0001. [OR 21 (3–133), P ≤ 0.002].

Conclusions
In patients with liver cirrhosis a urine protein:creatinine ratio >30 predicts AKI. Iohexol clearance and cystatin C formulae identify a greater proportion of patients with a GFR <60 mL/min/1.73 m2, which also predicts the development of AKI.
Original languageEnglish
Pages (from-to)989-997
Number of pages9
JournalAlimentary Pharmacology and Therapeutics
Volume37
Issue number10
DOIs
Publication statusPublished - May 2013

Keywords

  • GELATINASE-ASSOCIATED LIPOCALIN
  • CYSTATIN-C
  • TRANSPLANTATION
  • DISEASE
  • SERUM
  • IMPAIRMENT
  • MOLECULE-1
  • MORTALITY
  • ASCITES
  • MARKER

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