Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy
Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT), secondary to cardiovascular disease and sepsis, is associated with high in-hospital mortality. Although studies have examined cardiovascular disease and sepsis in AKI, the association between AKI and hepatic functional...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | Renal Failure |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2024.2352127 |
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| author | Takuya Nishino Yoshiaki Kubota Tetsuya Kashiwagi Akio Hirama Kuniya Asai Masahiro Yasutake Shinichiro Kumita |
| author_facet | Takuya Nishino Yoshiaki Kubota Tetsuya Kashiwagi Akio Hirama Kuniya Asai Masahiro Yasutake Shinichiro Kumita |
| author_sort | Takuya Nishino |
| collection | DOAJ |
| description | Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT), secondary to cardiovascular disease and sepsis, is associated with high in-hospital mortality. Although studies have examined cardiovascular disease and sepsis in AKI, the association between AKI and hepatic functional impairment remains unclear. We hypothesized that hepatic function markers would predict mortality in patients undergoing CRRT. We included 1,899 CRRT patients from a multi-centre database. In Phase 1, participants were classified according to the total bilirubin (T-Bil) levels on the day of, and 3 days after, CRRT initiation: T-Bil < 1.2, 1.2 ≤ T-Bil < 2, and T-Bil ≥ 2 mg/dL. In Phase 2, propensity score matching (PSM) was performed to examine the effect of a T-Bil cutoff of 1.2 mg/dL (supported by the Sequential Organ Failure Assessment score); creating two groups based on a T-Bil cutoff of 1.2 mg/dL 3 days after CRRT initiation. The primary endpoint was total mortality 90 days after CRRT initiation, which was 34.7% (n = 571). In Phase 1, the T-Bil, aspartate transaminase (AST), alanine transaminase (ALT), and AST/ALT (De Ritis ratio) levels at CRRT initiation were not associated with the prognosis, while T-Bil, AST, and the De Ritis ratio 3 days after CRRT initiation were independent factors. In Phase 2, T-Bil ≥1.2 mg/dL on day 3 was a significant independent prognostic factor, even after PSM [hazard ratio: 2.41 (95% CI; 1.84-3.17), p < 0.001]. T-Bil ≥1.2 mg/dL 3 days after CRRT initiation predicted 90-day mortality. Changes in hepatic function markers in acute renal failure may enable stratification of high-risk patients. |
| format | Article |
| id | doaj-art-8687f66446a1406ab9bd270ba7adf324 |
| institution | Kabale University |
| issn | 0886-022X 1525-6049 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj-art-8687f66446a1406ab9bd270ba7adf3242025-01-23T04:17:47ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492024-12-0146110.1080/0886022X.2024.2352127Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapyTakuya Nishino0Yoshiaki Kubota1Tetsuya Kashiwagi2Akio Hirama3Kuniya Asai4Masahiro Yasutake5Shinichiro Kumita6Department of Health Care Administration, Nippon Medical School, Tokyo, JapanDepartment of Cardiovascular Medicine, Nippon Medical School, Tokyo, JapanDepartment of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, JapanDepartment of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, JapanDepartment of Cardiovascular Medicine, Nippon Medical School, Tokyo, JapanDepartment of Health Care Administration, Nippon Medical School, Tokyo, JapanDepartment of Radiology, Nippon Medical School, Tokyo, JapanAcute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT), secondary to cardiovascular disease and sepsis, is associated with high in-hospital mortality. Although studies have examined cardiovascular disease and sepsis in AKI, the association between AKI and hepatic functional impairment remains unclear. We hypothesized that hepatic function markers would predict mortality in patients undergoing CRRT. We included 1,899 CRRT patients from a multi-centre database. In Phase 1, participants were classified according to the total bilirubin (T-Bil) levels on the day of, and 3 days after, CRRT initiation: T-Bil < 1.2, 1.2 ≤ T-Bil < 2, and T-Bil ≥ 2 mg/dL. In Phase 2, propensity score matching (PSM) was performed to examine the effect of a T-Bil cutoff of 1.2 mg/dL (supported by the Sequential Organ Failure Assessment score); creating two groups based on a T-Bil cutoff of 1.2 mg/dL 3 days after CRRT initiation. The primary endpoint was total mortality 90 days after CRRT initiation, which was 34.7% (n = 571). In Phase 1, the T-Bil, aspartate transaminase (AST), alanine transaminase (ALT), and AST/ALT (De Ritis ratio) levels at CRRT initiation were not associated with the prognosis, while T-Bil, AST, and the De Ritis ratio 3 days after CRRT initiation were independent factors. In Phase 2, T-Bil ≥1.2 mg/dL on day 3 was a significant independent prognostic factor, even after PSM [hazard ratio: 2.41 (95% CI; 1.84-3.17), p < 0.001]. T-Bil ≥1.2 mg/dL 3 days after CRRT initiation predicted 90-day mortality. Changes in hepatic function markers in acute renal failure may enable stratification of high-risk patients.https://www.tandfonline.com/doi/10.1080/0886022X.2024.2352127Acute kidney injurycontinuous renal replacement therapytotal bilirubinDe Ritis ratiohepatic functional impairment |
| spellingShingle | Takuya Nishino Yoshiaki Kubota Tetsuya Kashiwagi Akio Hirama Kuniya Asai Masahiro Yasutake Shinichiro Kumita Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy Renal Failure Acute kidney injury continuous renal replacement therapy total bilirubin De Ritis ratio hepatic functional impairment |
| title | Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy |
| title_full | Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy |
| title_fullStr | Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy |
| title_full_unstemmed | Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy |
| title_short | Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy |
| title_sort | hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy |
| topic | Acute kidney injury continuous renal replacement therapy total bilirubin De Ritis ratio hepatic functional impairment |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2024.2352127 |
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