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NAFLD and Diabetes are Associated with Post-TIPS Renal Dysfunction: An ALTA Group Study. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Ge, J. n., Lai, J. C., Boike, J. R., German, M. n., Jest, N. n., Morelli, G. n., Spengler, E. n., Said, A. n., Lee, A. n., Hristov, A. n., Desai, A. P., Junna, S. n., Pokhrel, B. n., Couri, T. n., Paul, S. n., Frenette, C. n., Christian-Miller, N. n., Laurito, M. n., Verna, E. C., Rahim, U. n., Goel, A. n., Das, A. n., Pine, S. n., Gregory, D. n., VanWagner, L. B., Kolli, K. P. 2020

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertensive complications, but its effect on renal function is not well-characterized. Here, we describe renal function and characteristics associated with renal dysfunction at 30-days post-TIPS.Adults with cirrhosis who underwent TIPS at nine hospitals in the US 2010-2015 were included. We defined "post-TIPS renal dysfunction" as a change in estimated glomerular filtration rate (?eGFR) = -15ml/min/1.73m2 and eGFR = 60ml/min/1.73m2 , or new renal replacement therapy (RRT) at day 30. We identified the characteristics associated with post-TIPS renal dysfunction by logistic regression and evaluated survival using adjusted competing risk regressions.Of 673 patients: median age 57 years, 38% female, 26% had diabetes, median MELDNa 17. Thirty days post-TIPS, 66 (10%) had renal dysfunction, of which 23 (35%) required new RRT. Patients with post-TIPS renal dysfunction, compared to those with stable renal function, were more likely to have NAFLD (33% versus 17%, p = 0.01) and comorbid diabetes (42% versus 24%, p < 0.01). Multivariate logistic regressions showed NAFLD (OR 2.04, 95%CI 1.00 to 4.17, p = 0.05), serum sodium (OR 1.06 per mEq/L, 95%CI 1.01 to 1.12, p = 0.03), and diabetes (OR 2.04, 95%CI 1.16 to 3.61, p = 0.01) were associated with post-TIPS renal dysfunction. Competing risk regressions showed those with post-TIPS renal dysfunction were at higher sub-hazard of death (sHR 1.74, 95%CI 1.18 to 2.56, p = 0.01).In this large multi-center cohort, we found NAFLD, diabetes, and baseline serum sodium associated with post-TIPS renal dysfunction. This study suggests that patients with NAFLD and diabetes undergoing TIPS evaluation may require additional attention to cardiac and renal comorbidities prior to proceeding with the procedure.

View details for DOI 10.1002/lt.25949

View details for PubMedID 33217178