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Urine albumin-to-creatinine ratio is associated with the severity of liver disease, renal function and survival in patients with decompensated cirrhosis

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Abstract

Background and aims

To investigate if urine albumin-to-creatinine ratio (UACR) is associated with the presence of glomerular filtration rate (GFR) <60 mL/min, severity of liver disease and survival in patients with stable decompensated cirrhosis.

Methods

We evaluated prospectively 220 patients (73 % male, age 52.8 ± 12 years). In each patient, assessment of GFR was based on 51chromium-EDTA. Random urine samples were obtained for measurement of UACR.

Results

Thirty-eight patients (17 %, group 1) had UACR ≥30 mg/g and 182 (83 %, group 2) had UACR <30 mg/g. Group 1, compared to group 2 patients, had significantly lower levels of “true” GFR (61 vs. 71 ml/min, p = 0.035). Patients with “true” GFR <60 mL/min (n = 93), compared to those with “true” GFR ≥60 mL/min (n = 127), had higher levels of UACR (16 vs. 11.3 mg/g, p = 0.023). In multivariate analysis, serum creatinine and UACR (ΟR 0.98, 95 % CI 0.95–0.99, p = 0.04) were independently associated with the presence of GFR <60 mL/min. Based on the area under the ROC curves, the best cut-off point for UACR was >16.51 mg/g giving a sensitivity 70 %, specificity 49 %, PPV 68 % and NPV 51 %. During the follow-up period [17 (6–52) months], the patients who died or underwent LT (n = 158), compared to those who remained alive (n = 62), had higher levels of UACR (41 vs. 13 mg/g, p = 0.025). Patients with UACR ≥30 mg/g had worse outcome, compared to those with UACR <30 mg/g (log rank p = 0.053).

Conclusions

We showed for the first time that UACR ≥30 mg/g was associated with more severe liver disease, lower GFR and worse LT-free survival in patients with decompensated cirrhosis. However, further studies are needed to confirm these findings.

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Abbreviations

24UNa:

24-h urine sodium excretion

AKI:

Acute kidney injury

aPTT:

Activated partial thromboplastin time

AUC:

Receiver operating characteristic curve

CKD:

Chronic kidney disease

CKD-EPI:

Chronic kidney disease–epidemiology

CTP:

Child-Turcotte-Pugh

DC:

Decompensated cirrhosis

eGFR:

Estimated GFR

GFR:

Glomerular filtration rate

HCC:

Hepatocellular carcinoma

INR:

International normalised ratio

LT:

Liver transplantation

MELD:

Model for end-stage liver disease

PLT:

Platelet count

PT:

Prothrombin time

RAAS:

Renin-angiotensin-aldosterone system

sCr:

Serum creatinine

UACR:

Urine albumin-to-creatinine ratio

UNa/K:

“Spot” sodium to potassium ratio

WBC:

White blood count

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Compliance with ethical standards

Conflict of interest

Evangelos Cholongitas, Ioannis Goulis, Maria Ioannidou, Stergios Soulaidopoulos, Parthenis Chalevas, Evangelos Akriviadis have no conflict of interest.

Financial disclosure

None.

Ethical standard

The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki.

Informed consent

Informed consent was signed by all patients.

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Authors and Affiliations

  1. 4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, Medical School Aristotle University of Thessaloniki, 49, Konstantinopoleos Street, 54642, Thessaloniki, Greece

    Evangelos Cholongitas, Ioannis Goulis, Maria Ioannidou, Stergios Soulaidopoulos, Parthenis Chalevas & Evangelos Akriviadis

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  1. Evangelos Cholongitas
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  2. Ioannis Goulis
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  3. Maria Ioannidou
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Correspondence to Evangelos Cholongitas.

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Cholongitas, E., Goulis, I., Ioannidou, M. et al. Urine albumin-to-creatinine ratio is associated with the severity of liver disease, renal function and survival in patients with decompensated cirrhosis. Hepatol Int 11, 306–314 (2017). https://doi.org/10.1007/s12072-016-9759-9

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  • DOI: https://doi.org/10.1007/s12072-016-9759-9

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