Determinants of Early Renal Function Recovery After TIPS in Patients With Portal Hypertension

Renal dysfunction frequently occurs in patients with portal hypertension and is linked to unfavorable clinical outcomes. Transjugular intrahepatic portosystemic shunt (TIPS) has the potential to enhance renal perfusion through portal decompression; however, factors predicting early improvement in renal function remain insufficiently defined. This retrospective, single-center study analyzed 188 consecutive patients with portal hypertension who underwent TIPS. Patients receiving renal replacement therapy or with baseline eGFR < 15 mL/min/1.73 m² were excluded. The primary endpoint was early renal function improvement, defined as a > 10% reduction in serum creatinine within 7 days. Early renal function improvement was observed in 27.7% of the cohort. Lower baseline eGFR was independently associated with higher probability of improvement (adjusted OR: 0.980, 95% CI: 0.966-0.993; p = 0.004). Neither pre- nor post-TIPS portal venous pressure nor the magnitude of pressure reduction was significantly associated with renal response. Restricted cubic spline analysis indicated a linear inverse relationship between baseline eGFR and improvement probability. The multivariable model demonstrated modest discriminative ability (AUC 0.666). Baseline renal function was associated with early post-TIPS early renal function improvement, whereas intra-procedural portal pressure parameters were not predictive. These findings suggest that early renal function improvement following TIPS may predominantly reflect reversible functional impairment rather than established structural kidney injury.