Background and aims
Transjugular intrahepatic porto-systemic shunt (TIPS) ameliorates renal function in type-2 hepatorenal syndrome (HRS). Available evidence is based on ‘old’ HRS diagnostic criteria, and not on the current definition of HRS – chronic kidney disease (HRS-CKD). Among patients who underwent TIPS for refractory ascites over the last 12 years, we investigated clinical and renal function evolution of those with HRS-CKD.
among 212 patients, 41 with HRS-CKD were included. Renal function was evaluated for 12 months after TIPS, along with management of ascites and transplant-free survival (TFS).
renal function significantly improved already one week after TIPS [serum creatinine (sCr): 1.37 ± 0.23 vs 1.94 ± 0.54 mg/dl, p< 0.001]; the amelioration was maintained during the whole follow-up and was observed in every CKD stage, defined according to baseline estimated Glomerular Filtration Rate (eGFR). sCr and eGFR became comparable between different CKD stages after only one week, whilst significantly different at baseline. TIPS led to a remarkable improvement in the control of ascites in all CKD stages and no significant differences in TFS were recorded.
TIPS led to an early, substantial and persistent improvement in renal function in patients with HRS-CKD, irrespective of their baseline CKD stage.
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- Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites.Gastroenterology. 1993; 105: 229-236
- Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis.Gut. 2007; 56: 1310-1318
- KDIGO clinical practice guidelines for acute kidney injury.Nephron Clin Pract. 2012; 120: c179-c184
- KDIGO 2012 Clinical practice guideline for the evaluation and management of chronic kidney disease.Kidney Int Suppl. 2013; 3: 1-150
- Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites.Gut. 2015; 64: 531-537
- News in pathophysiology, definition and classification of hepatorenal syndrome: a step beyond the International Club of Ascites (ICA) consensus document.J Hepatol. 2019; 71: 811-822
- Impact of liver transplantation on the survival of patients treated for hepatorenal syndrome type 1.Liver Transpl. 2011; 17: 1328-1332
- Liver transplant outcomes for patients with hepatorenal syndrome treated with pretransplant vasoconstrictors and albumin.Transplantation. 2011; 91: 1141-1147
- Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study.Gastroenterology. 2008; 134: 1352-1359
- Treatment of type 2 hepatorenal syndrome in patients awaiting transplantation: effects on kidney function and transplantation outcomes.Liver Transpl. 2015; 21: 1347-1354
- Noradrenalin vs terlipressin in patients with hepatorenal syndrome: a prospective, randomized, unblinded, pilot study.J Hepatol. 2007; 47: 499-505
- Noradrenaline vs terlipressin in the treatment of type 2 hepatorenal syndrome: a randomized pilot study.Liver Int. 2013; 33: 1187-1193
- Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study.Gut. 2000; 47: 288-295
- Renal failure in cirrhotic patients: role of terlipressin in clinical approach to hepatorenal syndrome type 2.Eur J Gastroenterol Hepatol. 2002; 14: 1363-1368
- TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update.Gut. 2010; 59: 988-1000
- TIPS: 25 years later.J Hepatol. 2013; 59: 1081-1093
- EASL clinical practice guidelines for the management of patients with decompensated cirrhosis.J Hepatol. 2018; 69: 406-460
- The management of ascites in cirrhosis: report on the consensus conference of The International Ascites Club.Hepatology. 2003; 38: 258-266
- Natural history of acute kidney disease in patients with cirrhosis.J Hepatol. 2021; 74: 578-583
- Renal function in cirrhosis: a critical review of available tools.Semin Liver Dis. 2018; 38: 230-241
- Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis.Gastroenterology. 2002; 123: 1839-1847
- Long-term clinical outcome of patients with cirrhosis and refractory acites treated with transjugular intrahepatic portosystemic shunt insertion.J Gastroenterol Hepatol. 2015; 30: 389-395
- Covered stents are better than uncovered stents for transjugular intrahepatic portosystemic shunts in cirrhotic patients with refractory ascites: a retrospective cohort study.Acta Gastroenterol Belg. 2010; 73: 336-341
- Hepatorenal syndrome in cirrhosis: pathogenesis and treatment.Gastroenterology. 2002; 122: 1658-1676
- Bile acids trigger cholemic nephropathy in common bile-duct-ligated mice.Hepatology. 2013; 58: 2056-2069
- Bile cast nephropathy is a common pathologic finding for kidney injury associated with severe liver dysfunction.Kidney Int. 2013; 84: 192-197
- LEFT ventricular function assessed by echocardiography in cirrhosis: relationship to systemic hemodynamics and renal dysfunction.J Hepatol. 2013; 58: 51-57
- Mechanisms of decompensation and organ failure in cirrhosis: from peripheral arterial vasodilation to systemic inflammation hypothesis.J Hepatol. 2015; 63: 1272-1284
- Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems.Hepatology. 1998; 28: 416-422
- Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome.Hepatology. 2004; 40: 55-64
- Influence of portal pressure change on intestinal permeability in patients with portal hypertension.Hepatobiliary Pancreat Dis Int. 2002; 1: 510-514
- Intestinal permeability in a patient with liver cirrhosis.Ther Clin Risk Manag. 2016; 12: 1729-1748
- Characterization of inflammatory response in hepatorenal syndrome: relationship with kidney outcome and survival.Liver Int. 2019; 39: 1246-1255
- The transjugular intrahepatic portosystemic shunt: an update.AJR Am J Roentgenol. 2012; 199: 746-755
- MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation.Hepatology. 2005; 41: 1282-1289
- Inaccuracies of creatinine and creatinine- based equations in candidates for liver transplantation with low creatinine: impact on the model for end-stage liver disease score.Liver Transpl. 2010; 16: 1169-1177
- Glomerular filtration rate equations for liver-kidney transplantation in patients with cirrhosis: validation of current recommendations.Hepatology. 2014; 59: 1514-1521
- Impact of chronic kidney disease on outcomes in cirrhosis.Liver Transpl. 2019; 25: 870-880
Published online: October 05, 2021
Accepted: September 14, 2021
Received: April 10, 2021
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.