INITIAL EVALUATION OF KIDNEY FUNCTION IN PATIENTS WITH LIVER CIRRHOSIS OF CEIHET, HIDALGO

Introduction and Objectives

Kidney injury has become one of the main causes of decompensation in cirrhotic patients. There are few studies in our country that compare various methods to assess kidney function in these patients. Objective: To evaluate the initial renal function in patients with liver cirrhosis from CEIHET, Hidalgo.

Material and methods

Observational, cross-sectional, retrospective and analytical study, selecting 186 files with a diagnosis of liver cirrhosis, from January 2020 to June 2021, evaluating renal function (MDRD-6, 24-hour urine creatinine clearance, KDIGO / CKD and Serum cystatin C) at the initial check-up appointment. Statistical analysis was performed through measures of central tendency, dispersion and correlation.

Results

186 files were analyzed, 53.2% (n = 99) women; mean age of 63 years and a mean time since the diagnosis of cirrhosis of 2.2 years. 117 patients (63%) Child Pugh A. The main etiology of cirrhosis was metabolic fatty liver in 110 patients (53.8%). At the time of the first visit, 140 patients (75.3%) had serum creatinine levels between 1 and 2 mg/dl, with a mean of 1.3. Regarding 24-hour urine creatinine clearance, 93 patients (50%) showed levels greater than 90ml / min, and 47 (25.2%) had levels less than 45ml / min. When measuring filtration rate by MDRD-6, 86 (46.4%) showed levels higher than 90ml / min, and 40 (21.5%) had levels lower than 45ml / min. Regarding KDIGO / CKD, 100 individuals (53.8%) showed rates greater than 90ml / min, and only 27 (14.5%) rates less than 45ml / min. In serum Cystatin C, 103 (55.5%) had levels between 1 and 1.5mg / L, and 50 (27%) showed levels greater than 1.5mg / L. When comparing the various measurements, there was only a statistical difference between KDIGO / CKD and the other scales, showing a lower rate of detection of initial kidney injury (p 0.008, 0.07 and 0.04). In total, 89 (48%) of the patients had creatinine clearance less than 60ml / min at the initial consultation. Discussion. In our study, almost half of the patients with cirrhosis present a degree of kidney damage from the first visit to Hepatology. It was impossible to determine whether it is acute, exacerbated chronic, or definitive chronic disease. The use of 24-hour urine creatinine clearance, serum cystatin C, and MDRD-6 is helpful since serum creatinine levels alone erroneously estimate the degree of kidney injury in these patients. We essentially consider the initial kidney function evaluation in all cirrhotic patients to identify probable causes and treat them.

Conclusions

We found that up to 48% of patients with liver cirrhosis present some degree of kidney injury at the time of their first consultation with Hepatology. 24-hour urine creatinine clearance, serum cystatin C, and MDRD-6 appear useful in evaluating renal function in these patients.

The authors declare that there is no conflict of interest