Your browser doesn't support javascript.
loading
Changes in Kidney Function After Transjugular Intrahepatic Portosystemic Shunts Versus Large-Volume Paracentesis in Cirrhosis: A Matched Cohort Analysis.
Allegretti, Andrew S; Ortiz, Guillermo; Cui, Jie; Wenger, Julia; Bhan, Ishir; Chung, Raymond T; Thadhani, Ravi I; Irani, Zubin.
Afiliação
  • Allegretti AS; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA. Electronic address: aallegretti@partners.org.
  • Ortiz G; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Cui J; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Wenger J; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Bhan I; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Chung RT; Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Thadhani RI; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Irani Z; Department of Radiology, Massachusetts General Hospital, Boston, MA.
Am J Kidney Dis ; 68(3): 381-91, 2016 Sep.
Article em En | MEDLINE | ID: mdl-26994685
ABSTRACT

BACKGROUND:

Patients with cirrhosis and refractory ascites have physiologic and hormonal dysregulation that contributes to decreased kidney function. Placement of a transjugular intrahepatic portosystemic shunt (TIPS) can reverse these changes and potentially improve kidney function. We sought to evaluate change in estimated glomerular filtration rate (eGFR) following TIPS placement. STUDY

DESIGN:

Retrospective, matched cohort analysis. SETTINGS &

PARTICIPANTS:

Patients who underwent first-time TIPS placement for refractory ascites in 1995 to 2014. Frequency matching was used to generate a comparator group of patients with cirrhosis and ascites treated with serial large-volume paracentesis (LVP) in a 11 fashion. PREDICTOR TIPS placement compared to serial LVP.

OUTCOME:

Change in eGFR over 90 days' follow-up. MEASUREMENTS Multivariable regression stratified by baseline eGFR<60 versus ≥60mL/min/1.73m(2); analysis of effect modification between TIPS placement and baseline eGFR.

RESULTS:

276 participants (TIPS, n=138; serial LVP, n=138) were analyzed. After 90 days, eGFRs increased significantly after TIPS placement in participants with baseline eGFRs<60mL/min/1.73m(2) compared to treatment with serial LVP (21 [95% CI, 13-29] mL/min/1.73m(2); P<0.001) and was no different in those with eGFRs≥60mL/min/1.73m(2) (1 [95% CI, -9 to 12] mL/min/1.73m(2); P=0.8). There was significant effect modification between TIPS status and baseline eGFR (P=0.001) in a model that included all participants.

LIMITATIONS:

Outcomes restricted by clinically recorded data; clinically important differences may still exist between the TIPS and LVP cohorts despite good statistical matching.

CONCLUSIONS:

TIPS placement was associated with significant improvement in kidney function. This was most prominent in participants with baseline eGFRs<60mL/min/1.73m(2). Prospective studies of TIPS use in populations with eGFRs<60mL/min/1.73m(2) are needed to evaluate these findings.
Assuntos
Palavras-chave

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Paracentese / Derivação Portossistêmica Transjugular Intra-Hepática / Rim / Cirrose Hepática Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Revista: Am J Kidney Dis Ano de publicação: 2016 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Paracentese / Derivação Portossistêmica Transjugular Intra-Hepática / Rim / Cirrose Hepática Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Revista: Am J Kidney Dis Ano de publicação: 2016 Tipo de documento: Article