Introduction
Acute kidney injury is a complication in patients with decompensated cirrhosis (26%). Hepatorenal syndrome has high morbidity and mortality (90%), characterized by renal functional circulatory changes. Abdominal ultrasound, as a medical tool, in the VexUS protocol assessing intravascular congestion (Inferior vena cava, suprahepatic vein, portal vein, and renal vein), could be routinely used in cirrhotic patients with acute kidney injury to objectify the degree of venous congestion and improve decision-making, changing the treatment paradigm with albumin.
Aims & Methods
Prospective, observational, and analytical cohort study in hospitalized hepatic cirrhosis patients with acute kidney injury due to acute decompensation, receiving intravenous albumin at a dose of 1 g/kg/day for 48 hours with subsequent assessment of response. Before albumin administration, abdominal ultrasound (VExUS) was performed to determine the venous congestion status (Period: July 2022 to December 2023). No sample calculation was performed, as all patients meeting selection criteria were included. Sociodemographic, clinical, and biochemical variables were recorded.
Results
Out of 36 patients, 16 (44.4%) responded to albumin therapy, while 20 (55.6%) did not respond. Analyzing according to the VExUS score, 12 patients with VExUS 0 had a response rate of 54.5%, and 10 did not respond (45.5%). When classifying patients based on the presence or absence of venous congestion (VExUS = 0 vs. VExUS 1 or 2), it was observed that in patients with venous congestion, 4 responded (28.6%) and 10 did not respond (71.4%), with a decrease in the p-value without reaching statistical significance.
A logistic regression analysis revealed that both the VExUS score and serum creatinine at admission are predictors of non-response to albumin. The presence of congestion (VExUS I or II) and a 1 mg/dL increase in creatinine were associated with a 5 and 10 times higher risk of non-response, respectively. Regarding the MELD Na score, the 14 deceased patients had a median of 32.5, while the 22 survivors had a median of 23.77.
Conclusion
Non-invasive diagnostic tools like ultrasound (VexUs), widely used due to availability, prove useful in determining the volume status of cirrhotic patients with acute kidney injury and hepatorenal syndrome. This helps establish the prognosis of response to a volume expander like albumin or the utility of other targeted therapeutic measures in patients with evidence of volume overload and/or abdominal hypertension data.
References
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