Aims and objectives
Renal dysfunction can be a complication in up to 50% of patients with cirrhosis and ascites,
and is thought to be due to decreased renal perfusion [1].
This may be because portal hypertension present in cirrhosis may lead to splachnic vasodilation and decreased effective intravascular volume [2].
Diabetes,
which is present in up to 30% of patients with cirrhosis,
can also lead to renal dysfunction [3].
The purpose of our study is to determine how diabetic status affects renal function and survival after TIPS placement...
Methods and materials
We retrospectively reviewed the medical records of 422 patients who had TIPS placed between September 2004 and September 2015,
excluding patients without documentation of comorbidities.
The patients were divided into diabetics (n=187) and non-diabetics (n=226).
61.8% of patients were male and 88.4% Caucasian.
We measured renal function using Glomerular Filtration Rate (GFR) calculated from recorded serum creatinine values pre-procedure and within 1 month after TIPS placement.
We calculated the Model for End-stage-Liver Disease (MELD) score based on lab values pre-procedure and within 1 month after...
Results
Analyzing the demographics of our population,
there was a significant difference in age but not in gender or ethnicity between diabetics and non-diabetics ( Table 1 ).
There was no significant change in GFR in either diabetics or non-diabetics.
The mean for both groups increased after TIPS placement ( Table 2 ).
There was a significant change in MELD score in both diabetics and non-diabetics.
The mean for both groups increased after TIPS placement ( Table 3 ).
Lower pre-TIPS GFR was significantly associated with...
Conclusion
GFR is significantly lower in diabetic patients regardless of TIPS placement,
supporting the assumption that diabetes has an additive effect on worsening renal function in patients with cirrhosis.
However,
TIPS placement does not significantly change the GFR in diabetics or non-diabetics at 1 month post procedure.
MELD score is significantly higher in diabetic patients before TIPS placement but not after TIPS placement.
Despite similar post-TIPS MELD scores,
diabetics had worse mortality compared to non-diabetics.
TIPS placement did increase MELD scores in both diabetic and non-diabetic...
Personal information
Ahmed KamelAbdel Aal ,
MD,PhD,
FSIR
University of Alabama at Birmingham (UAB).
Department of Radiology
Division ofInterventional Radiology.
United States ,
Alabama.
Address: 619 19th Street South,
Birmingham,
AL 35249.
Tel:(205) 975-4850
Fax: (205) 975-5257.
Email:
[email protected]
Twitter: ahmed_kamel_ir
References
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Acute Kidney Injury in Patients with Cirrhosis.
Journal of Clinical and Translational Hepatology. 2015;3(3):195-204.
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Betrosian AP,
Agarwal B,
Douzinas EE.
Acute renal dysfunction in liver diseases.
World Journal of Gastroenterology : WJG.
2007;13(42):5552-5559.
3.
Garcia-Compean D,
Jaquez-Quintana JO,
Gonzalez-Gonzalez JA,
Maldonado-Garza H.
Liver cirrhosis and diabetes: Risk factors,
pathophysiology,
clinical implications and management.
World Journal of Gastroenterology : WJG. 2009;15(3):280-288.