Renal impairment is associated with increased risk of mortality in patients with cirrhosis: A retrospective cohort study

Although renal impairment is a frequent complication in cirrhosis that is associated with a poor prognosis, little has been reported on the clinical significance of renal impairment in cirrhosis in Japan. This retrospective study assessed the impact of renal impairment on mortality in Japanese cirrhosis patients taking conventional diuretics. A total of 157 patients with cirrhosis receiving diuretic treatment were evaluated for the presence and status of renal impairment, defined as an increase in serum creatinine of ≥ 0.3 mg/dL or by ≥ 50%, and then classified according to the International Club of Ascites (ICA)-Acute Kidney Injury (AKI) staging system. Eighty of 157 (51%) patients fulfilled the criteria for renal impairment. Thirty-four (43%) patients had ICA-AKI stage 1, 32 (40%) stage 2, and 14 (18%) stage 3. Multivariate analysis revealed female gender (hazard ratio [HR] = 0.407, 95% confidence interval = 0.193–0.857; P = .018), ALT ≥35 IU/L (HR = 3.841, 95% confidence interval = 1.785–8.065; P = .001), and the presence of renal impairment (HR = 4.275, 95% confidence interval = 1.962–9.312; P < .001) as independent factors significantly increasing the risk of mortality. Cumulative survival rates increased significantly with ICA–AKI stage (log-rank test, P = .009). Renal impairment was a predictive marker of mortality in Japanese patients with cirrhosis. Stratification according to ICA–AKI criteria of kidney function impairment may be a good prognostic indicator of cirrhosis outcome.