Faculty Collaboration Database

Update on Assessment of Estimated Glomerular Filtration Rate in Patients With Cirrhosis. Adv Kidney Dis Health 2023 Jul;30(4):307-314

Date

06/30/2023

Pubmed ID

37389536

DOI

10.1053/j.akdh.2023.06.001

Scopus ID

2-s2.0-85186295119 (requires institutional sign-in at Scopus site)

Abstract

Kidney disease is associated with adverse outcomes in patients with cirrhosis including increased post-liver transplantation (LT) mortality. Therefore, diagnosis and staging of kidney disease are critical to timely implementation of treatment and have important implications for transplant eligibility. Serum creatinine (sCr) is a key component of the Model for End-Stage Liver Disease score in LT candidates, and sCr-based estimated glomerular filtration rate (eGFR) values play an important role in determining medical urgency for LT. However, the use of sCr to assess kidney function may be limited in the cirrhotic milieu due to decreased creatinine production, interference of bilirubin with some laboratory assays for sCr, and expansion of the volume of distribution of creatinine. Therefore, conventional eGFR equations perform poorly in patients with cirrhosis and may overestimate kidney function leading to delayed diagnosis of acute kidney injury or lower priority for LT in patients with a truly low glomerular filtration rate. In this review, we will provide an update on the use of sCr for diagnosis and staging of kidney disease in patients with cirrhosis, discuss the limitations of sCr-based eGFR equations, and discuss novel eGFR equations that have been developed in patients with cirrhosis.

Author List

Griffin C, Asrani SK, Regner KR

Author

Kevin R. Regner MD Interim Chair, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Creatinine
Cystatin C
End Stage Liver Disease
Glomerular Filtration Rate
Humans
Liver Cirrhosis
Severity of Illness Index