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Contrast-induced Acute Kidney Injury in Patients with Liver Cirrhosis: A Retrospective Analysis
Zain Ul Abideen1, Syed Nayer Mahmud2, Mohammad Salih3
1Nephrology and Renal Transplant, Royal Cornwall Hospital, Truro, GBR.
Insights
Patients with liver cirrhosis (LC) undergoing contrast-enhanced computed tomography scans face a 5.1% risk of contrast-induced acute kidney injury (CI-AKI). Advanced liver disease severity, indicated by MELD and Child-Pugh scores, significantly predisposes patients to CI-AKI.
Area of Science:
- Nephrology
- Hepatology
- Radiology
Background:
- Contrast-induced acute kidney injury (CI-AKI) risk in liver cirrhosis (LC) patients is understudied.
- Liver cirrhosis is prevalent in Pakistan, with patients frequently undergoing contrast-enhanced computed tomography (CECT).
- Limited data exists on CI-AKI incidence and risk factors in LC patients, especially in Pakistan.
Purpose of the Study:
- To determine the frequency of CI-AKI in liver cirrhosis patients undergoing CECT.
- To identify significant predisposing factors for CI-AKI in this patient population.
Main Methods:
- Retrospective analysis of 470 liver cirrhosis patients' records.
- Assessment of CI-AKI development post-CECT.
- Correlation of CI-AKI with liver disease severity scores (MELD, MELD-Na, Child-Pugh) and laboratory parameters (INR, bilirubin, bicarbonate, sodium).
Main Results:
- The overall frequency of CI-AKI was 5.1%.
- Higher MELD, MELD-Na, and Child-Pugh scores were significantly associated with CI-AKI (p<0.05).
- CI-AKI patients exhibited higher INR and serum bilirubin, and lower venous bicarbonate and serum sodium levels (p<0.05).
Conclusions:
- Advanced liver disease and impaired liver synthetic function increase susceptibility to CI-AKI.
- Severity scores like MELD and Child-Pugh are crucial indicators of CI-AKI risk in LC patients.
- Further research into bicarbonate therapy for CI-AKI prevention in LC is warranted.
Abstract:
Contrast-induced acute kidney injury (CI-AKI) has been studied less extensively in patients with liver cirrhosis (LC). It is unclear whether the presence of severe liver disease is actually a predisposing factor for CI-AKI. Liver cirrhosis is extremely common in Pakistan and is attributed to the high prevalence of chronic viral hepatitis. Patients with LC often undergo contrast-enhanced computed tomograms (CECT) for various diagnostic and therapeutic purposes, and there have been concerns regarding them being at risk for CI-AKI. The available literature on this topic is scanty, and no study has been conducted in Pakistan. The purpose of this study, therefore, was to determine the frequency of CI-AKI in patients with LC undergoing CECT and to determine any significant predispositions. We retrospectively analyzed the records of 470 LC patients at our center. The frequency of CI-AKI in our study was 5.1%. A higher mean model for end-stage liver disease (MELD), MELD including sodium (MELD-Na), and Child-Pugh (CP) scores was significantly associated with developing CI-AKI (p<0.05). Patients with CI-AKI also had a significantly higher mean international normalized ratio (INR) and serum bilirubin levels, with lower mean venous bicarbonate and serum sodium levels (p<0.05). Our results show that patients with a more advanced liver disease and poorer synthetic function are increasingly susceptible to developing CI-AKI. Further studies can investigate the role of bicarbonate therapy in preventing CI-AKI in LC.
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