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      Is There any Difference Between the Glomerular Filtration Rate of Patients With Chronic Hepatitis B and C and Patients With Cirrhosis?

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          Abstract

          Background

          Renal dysfunction is a major determinant of the Model of End-stage Liver Disease (MELD) score. The implementation of the MELD score has shifted allocation of livers to patients with renal dysfunction.

          Objectives

          The aim of our study was the assessment of estimated Glomerular Filtration Rate (eGFR) by the Modification of Diet in Renal Disease 4 (MDRD4) method in patients with HBV chronic hepatitis, HCV chronic hepatitis, and cirrhosis (CH) caused by these viruses to detect any differences in renal function among these diseases.

          Patients and Methods

          We performed a cross-sectional analysis of all consecutive patients with HBV chronic hepatitis, HCV chronic hepatitis, and cirrhosis caused by these viruses hospitalized during a 4 year period in the Gastroenterology and Hepatology department of the Emergency County Hospital Timisoara, Romania. The eGFR was assessed by the MDRD4 method. Statistical analysis (unpaired t-test, ANOVA, Chi Square test) was performed using OpenEpi 2.3.1.

          Results

          HBV chronic hepatitis, HCV chronic hepatitis, and cirrhosis secondary to these viruses were associated with a reduction of the GFR. The eGFR was higher in patients with HBV chronic hepatitis than in patients with HCV chronic hepatitis (P < 0.001). Patients with cirrhosis secondary to HBV infection had a higher eGFR than patients with cirrhosis secondary to HCV (P = 0.01). The eGFR of patients with HCV chronic hepatitis was higher than the eGFR of patients with cirrhosis due to this virus (P < 0.001).

          Conclusions

          Functional renal impairment in diseases caused by HCV was more important than in diseases caused by HBV. The eGFR was statistically lower in cirrhosis secondary to HCV than in HCV chronic hepatitis.

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          Most cited references10

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          Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis.

          P Angeli, Eduardo A. Bortoluzzi, F Alberino … (1994)
          Several studies carried out in a limited number of patients demonstrated a wide range of overestimation of glomerular filtration rate (GFR) by serum creatinine level and creatinine clearance (Ccr) in liver disease. We simultaneously evaluated Ccr, inulin clearance, and predicted GFR calculated from serum creatinine level in 56 cirrhotic patients. Inulin clearance was considered the gold standard for GFR evaluation. The sensitivity of serum creatinine level, predicted GFR, and Ccr in detecting renal failure was 18.5%, 51%, and 74%, respectively. On the basis of inulin clearance, patients were divided into two groups: those with normal GFR (mean, 106 +/- 34 mL/min per 1.73 m2) (group 1, 29 patients) and those with reduced GFR (mean, 56 +/- 19 mL/min per 1.73 m2) (group 2, 27 patients). Predicted GFR and Ccr were accurate markers of GFR in group 1 patients, while both overestimated GFR by about 50% in group 2 patients. An increased tubular secretion of creatinine accounted for the disparity between Ccr and inulin clearance in these patients. Our results indicate that renal failure is greatly underestimated on the basis of serum creatinine level and Ccr in cirrhotic patients. Clinical implications of this observation include excessive dosage of potentially nephrotoxic drugs and failure to recognize renal impairment induced by such medical treatments as diuretic therapy or paracentesis.
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            Measured creatinine clearance from timed urine collections substantially overestimates glomerular filtration rate in patients with liver cirrhosis: a systematic review and individual patient meta-analysis.

            Alaa Rostom, N Proulx, J Jaffey … (2005)
            Accurate glomerular filtration rate (GFR) assessment in patients with liver cirrhosis is important for prognostication, chronic kidney disease staging, drug dosing and identifying combined liver-kidney transplantation candidates. The objective of this study was to review the accuracy of measured creatinine clearance (MCrCl) from timed urine collections for estimating true GFR. A systematic review and individual patient meta-analysis was performed. MEDLINE, old MEDLINE, Index Medicus and Cochrane library bibliographic databases and conference proceedings were searched up to June 2004. Reference lists of relevant studies were searched and experts were contacted. Comparative diagnostic studies describing stable adult patients with cirrhosis categorized according to the Child-Pugh classification were included if a gold standard GFR measurement was performed within 3 days of MCrCl. Individual patient data were abstracted from graphs of primary articles to allow a pooled analysis of agreement between renal measures. Seven studies of 193 patients from 1974 to 2002 were summarized. MCrCl overestimated inulin clearance (CIn) by a mean of +13 ml/min/1.73 m2 and the limits of agreement (mean of the differences+/-2 SD) were +60 ml/min/1.73 m2 and -34 ml/min/1.73 m2. This overestimation was highest in patients with lower GFR. The mean clearance ratios [95% confidence interval (CI)] between MCrCl and CIn in the high (> or =60 ml/min/1.73 m2) and low ( or =60 ml/min/1.73 m2 had a CIn of <30 ml/min/1.73 m2. For patients with liver cirrhosis, MCrCl from timed urine collections consistently overestimates the true GFR. For patients requiring complete clinical evaluation, GFR assessment by CIn is justified.
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              Hepatitis C virus infection and the prevalence of renal insufficiency.

              Joshua Sampson, Tin Louie, Thomas D Koepsell … (2007)
              Hepatitis C virus (HCV) is associated with pathologic changes in the kidney. However, the association between HCV and renal dysfunction is not well defined. This study estimated the prevalence of renal insufficiency among veterans who received care through the Veterans Affairs Puget Sound Health Care System. The study population consisted of veterans who underwent HCV antibody testing between January 1, 1999, and December 31, 2004, and had at least one primary care or medical subspecialty visit and at least one outpatient creatinine measurement within the 18 mo before antibody testing. Veterans were excluded when they had a history of chronic dialysis, creatinine >5 mg/dl, or renal transplantation. Study data were extracted from the electronic medical record. Renal insufficiency was defined as a creatinine level > or =1.5 mg/dl. Multivariate logistic regression was performed to estimate the risk for renal insufficiency associated with HCV. Among 25,782 eligible veterans, 1928 were HCV antibody positive and 23,854 were HCV antibody negative. Although the proportion with renal insufficiency was lower for antibody-positive versus -negative veterans (4.8 versus 6.0%), after adjustment for age, race, gender, diabetes, and hypertension, HCV-positive veterans had a 40% higher odds for renal insufficiency (odds ratio 1.40; 95% confidence interval 1.11 to 1.76) as compared with HCV-negative veterans. HCV was associated with an increased prevalence of renal insufficiency.
              Article 0 comments Cited 23 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Hepat Mon
                Journal ID (iso-abbrev): Hepat Mon
                Journal ID (doi): 10.5812/hepatmon
                Journal ID (publisher-id): Kowsar
                Title: Hepatitis Monthly
                Publisher: Kowsar
                ISSN (Print): 1735-143X
                ISSN (Electronic): 1735-3408
                Publication date (Electronic): 15 April 2013
                Publication date Collection: April 2013
                Volume: 13
                Issue: 4
                Electronic Location Identifier: e6789
                Affiliations
                [12423]
                [1 ]Division of Nephrology, University of Medicine and Pharmacy (V. Babes), Timisoara, Romania
                [2 ]Emergency County Hospital, University of Medicine and Pharmacy (V. Babes), Timisoara, Romania
                [3 ]Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy (V. Babes), Timisoara, Romania
                [4 ]Division of Gastroenterology and Hepatology, University of Medicine and Pharmacy (V. Babes), Timisoara, Romania
                Author notes
                [* ]Corresponding author: Cristina Gluhovschi, Division of Nephrology, University of Medicine and Pharmacy (V. Babes), Calea Aradului No. 8 Ap.16, 300088 Timisoara, Romania, Tel.: +40-256435950, Fax: +40-256486967, E-mail: gluh@ 123456umft.ro .
                Article
                DOI: 10.5812/hepatmon.6789
                PMC ID: 3693541
                PubMed ID: 23805157
                SO-VID: be3b9884-9814-4e8a-a85c-4ad781b5e85b
                Copyright © Copyright © 2013, Kowsar Corp.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 June 2012
                Date revision received : 14 August 2012
                Date accepted : 28 December 2012
                Categories
                Subject: Brief Report

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: hepatitis b virus,hepatitis c,liver cirrhosis,glomerular filtration rate
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: hepatitis b virus, hepatitis c, liver cirrhosis, glomerular filtration rate

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