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Belmonte R, Silva-Rodriguez M, Barbé F, Bensenane M, Haghenejad V, Vrillon I, Alla A, Flahault A, Kormann R, Corbel A, Aitdjafer Z, Quilliot D, Derain-Dubourg L, Namour F, Guéant JL, Bronowicki JP, Oussalah A. Multiparametric renal function assessment in cirrhotic patients shows high prevalence of medically actionable changes in multiple modules. Hepatol Res 2024. [PMID: 38662338 DOI: 10.1111/hepr.14050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/24/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
AIM Renal dysfunction is a common complication of cirrhosis, occurring either as part of multiorgan involvement in acute illness or secondary to advanced liver disease. To date, no study has comprehensively assessed multiple renal function parameters in hospitalized patients with cirrhosis through a multiparametric analysis of renal biochemistry markers. METHODS We conducted a retrospective, observational study including all consecutive patients hospitalized with cirrhosis who underwent a 43-multiparametric renal function assessment between January 1, 2021, and June 30, 2023. RESULTS All patients showed at least one of the following renal abnormalities: Kidney Disease: Improving Global Outcomes stage G2 or higher, sodium and/or chloride excretion fraction <1%, electrolyte-free water clearance <0.4 mL/min, or tubular maximum phosphate reabsorption capacity <0.8 mmol/L. The estimated glomerular filtration rate equations significantly overestimated the measured creatinine clearance with median differences of +14 mL/min/1.73 m2 (95% CI 6-29) and +9 mL/min/1.73 m2 (95% CI 2-15) for European Kidney Function Consortium equations, respectively. Notably, 54% and 39% of patients demonstrated estimated glomerular filtration rates exceeding 30% of the measured creatinine clearance when the Chronic Kidney Disease - Epidemiology Collaboration and European Kidney Function Consortium formulas were employed, respectively. Substantial discrepancies in Kidney Disease: Improving Global Outcomes stage assignments were observed between the estimated glomerular filtration rate- and measured creatinine clearance-based assessments. CONCLUSIONS This study underscores the value of a multiparametric renal function assessment as a routine tool for evaluating renal function in patients with cirrhosis. A high prevalence of medically actionable renal abnormalities spanning multiple renal function modules, including alterations in glomerular function, salt and solute-free water excretion, and proximal tubule phosphate reabsorption, has been demonstrated in hospitalized patients with cirrhosis.
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Affiliation(s)
- Richard Belmonte
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, University Hospital of Nancy, Nancy, France
- Reference Medical Biology Laboratory for Biochemical and Molecular Explorations of Uro-nephrological Diseases, University Hospital of Nancy, Nancy, France
| | - Maël Silva-Rodriguez
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, University Hospital of Nancy, Nancy, France
- Reference Medical Biology Laboratory for Biochemical and Molecular Explorations of Uro-nephrological Diseases, University Hospital of Nancy, Nancy, France
| | - Françoise Barbé
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, University Hospital of Nancy, Nancy, France
- Reference Medical Biology Laboratory for Biochemical and Molecular Explorations of Uro-nephrological Diseases, University Hospital of Nancy, Nancy, France
| | - Mouni Bensenane
- Department of Gastroenterology and Liver Diseases, University Hospital of Nancy, Nancy, France
| | - Vincent Haghenejad
- Department of Gastroenterology and Liver Diseases, University Hospital of Nancy, Nancy, France
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France
| | - Isabelle Vrillon
- Pediatric Nephrology Unit, University Hospital of Nancy, Nancy, France
| | - Asma Alla
- Department of Nephrology, University Hospital of Nancy, Nancy, France
| | - Adrien Flahault
- Department of Nephrology, University Hospital of Nancy, Nancy, France
| | - Raphael Kormann
- Department of Nephrology, University Hospital of Nancy, Nancy, France
| | - Alice Corbel
- Department of Nephrology, University Hospital of Nancy, Nancy, France
| | - Zakia Aitdjafer
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, University Hospital of Nancy, Nancy, France
- Reference Medical Biology Laboratory for Biochemical and Molecular Explorations of Uro-nephrological Diseases, University Hospital of Nancy, Nancy, France
| | - Didier Quilliot
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France
- Department of Endocrinology Diabetology and Nutrition, University Hospital of Nancy, Nancy, France
| | - Laurence Derain-Dubourg
- Nephrology, Dialysis, Hypertension and Functional Renal Exploration, Edouard Herriot Hospital, Hospices Civils de Lyon and Université Lyon 1, Lyon, France
| | - Farès Namour
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, University Hospital of Nancy, Nancy, France
- Reference Medical Biology Laboratory for Biochemical and Molecular Explorations of Uro-nephrological Diseases, University Hospital of Nancy, Nancy, France
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France
- Reference Center for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy, France
| | - Jean-Louis Guéant
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, University Hospital of Nancy, Nancy, France
- Reference Medical Biology Laboratory for Biochemical and Molecular Explorations of Uro-nephrological Diseases, University Hospital of Nancy, Nancy, France
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France
- Reference Center for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy, France
| | - Jean-Pierre Bronowicki
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, University Hospital of Nancy, Nancy, France
- Department of Gastroenterology and Liver Diseases, University Hospital of Nancy, Nancy, France
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France
| | - Abderrahim Oussalah
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, University Hospital of Nancy, Nancy, France
- Reference Medical Biology Laboratory for Biochemical and Molecular Explorations of Uro-nephrological Diseases, University Hospital of Nancy, Nancy, France
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France
- Reference Center for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy, France
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Asada S, Namisaki T, Kaji K, Takaya H, Kubo T, Akahane T, Kawaratani H, Nishimura N, Takeda S, Masuda H, Shibamoto A, Inoue T, Iwai S, Tomooka F, Tsuji Y, Fujinaga Y, Kitagawa K, Mitoro A, Sato S, Matsumoto M, Yoshiji H. VWF/ADAMTS13 Ratio as a Potential Predictive Biomarker for Acute Kidney Injury Onset in Cirrhosis. Dig Dis Sci 2024; 69:851-869. [PMID: 38244124 DOI: 10.1007/s10620-023-08257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024]
Abstract
AIM We investigated the von Willebrand factor to ADAMTS13 ratio (von Willebrand factor [VWF]:Ag/ADAMTS13:AC) as a potential biomarker for the outcomes of acute kidney injury (AKI) in liver cirrhosis (LC). METHODS This retrospective cross-sectional study included patients with LC who developed AKI (AKI group: n = 91) and patients with LC who did not develop AKI [non-AKI (NAKI) group, n = 91] as a control group. Plasma levels of the von Willebrand factor antigen (Ag) and ADAMTS13 activity (AC) were measured in patients with AKI or NAKI. Moreover, risk factors for onset of AKI, AKI-associated 90-day mortality, and poor AKI treatment response were identified. RESULTS The AKI group had a significantly higher VWF:Ag/ADAMTS13:AC than the NAKI group. Values of VWF:Ag/ADAMTS13:AC ≥ 5.7 were identified as risk factors for AKI onset in patients with LC (odds ratio [OR] 2.56; 95% CI 1.26-4.99; p < 0.001). Among patients with AKI, values of VWF:Ag/ADAMTS13:AC ≥ 9.0 were identified as risk factors for 90-day mortality (OR 6.83; 95% CI 2.32-20.10; p < 0.001). Cumulative survival was significantly lower in those with high (≥ 9.0) than in those with low (< 9.0) VWF:Ag/ADAMTS13:AC. Furthermore, values of VWF:Ag/ADAMTS13:AC ≥ 7.4 were identified as risk factors for poor treatment response (OR 4.2; 95% CI 1.39-12.70; p < 0.001). The treatment response rates were significantly higher in those with low (< 7.4) VWF:Ag/ADAMTS13:AC than in those with high (≥ 7.4) VWF:Ag/ADAMTS13:AC. CONCLUSION VWF:Ag/ADAMTS13:AC potentially predicts the onset, prognosis, and treatment response of AKI in patients with LC.
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Affiliation(s)
- Shohei Asada
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan.
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Takahiro Kubo
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Soichi Takeda
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Hiroyuki Masuda
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Akihiko Shibamoto
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Takashi Inoue
- Department of Evidence-Based Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Satoshi Iwai
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Fumimasa Tomooka
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Yuki Tsuji
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Koh Kitagawa
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Akira Mitoro
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Shinya Sato
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Masanori Matsumoto
- Department of Hematology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
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