3 years ago

Estimation of renal function in patients with liver cirrhosis: Impact of muscle mass and sex

Jeong-ju Yoo, Sang Gyune Kim, Young Seok Kim, Bora Lee, Min Hee Lee, Soung Won Jeong, Jae Young Jang, Sae Hwan Lee, Hong Soo Kim, Young Don Kim, Gab Jin Cheon

Publication date: Available online 8 January 2019

Source: Journal of Hepatology

Author(s): Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim, Bora Lee, Min Hee Lee, Soung Won Jeong, Jae Young Jang, Sae Hwan Lee, Hong Soo Kim, Young Don Kim, Gab Jin Cheon

Abstract
Background & aims

Accurate evaluation of renal function in patients with liver cirrhosis is critical for clinical management. However, discrepancy still exists between the measured GFR (mGFR) and Cr-based estimated GFR (eGFR). In this study, we compared the performance of two common eGFR measurements with mGFR, and evaluated the impact of low muscle mass on overestimation of renal function.

Methods

This study included 779 consecutive cirrhotic patients who underwent 51Cr- ethylenediamine tetra acetic acid (EDTA) (as a mGFR) and abdominal computed tomography (CT). The eGFR was calculated using Cr or cystatin C, respectively. Muscle mass was assessed in terms of the total skeletal muscle at L3 level using CT.

Results

Modification of Diet in Renal Disease (MDRD)-eGFR was overestimated in 47% of the whole patients. A multivariate analysis showed that female sex (adjusted odds ratio [aOR], 4.91), Child B and C vs. A (aOR, 1.69 and 1.84), and decreased skeletal muscle mass (aOR, 0.89) were independent risk factors associated with overestimation. Interestingly, the effect of skeletal muscle mass on overestimation varied upon sex. Decreased muscle mass significantly enhanced the risk of overestimation of MDRD-eGFR in male, but not in female patients. Cystatin C- based eGFR showed better correlation with mGFR and, better predictability for overall survival and incidence of acute kidney injury compared with MDRD-eGFR.

Conclusions

The risk factors associated with overestimation included female sex, impaired liver function, and decreased muscle mass. Especially, eGFR in male patients with sarcopenia should be carefully interpreted. Cr-based eGFR was overestimated more often than cystatin C-based eGFR, which was closely related with poor performance for the prediction of patients’ outcome.

Lay summary

Renal function overestimation occurs frequently in patients with liver cirrhosis when using serum creatinine. Decreased muscle mass has a great impact on overestimation of kidney function especially in male patients with cirrhosis. Compared with creatinine, Cystatin C was more closely correlated with mGFR with a higher predictive ability compared with Cr for renal complications and survival.

Graphical abstract

Graphical abstract for this article

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