Abstract: SA-OR102

Ultrasonography-Based Volume Status Assessment Unveils Misclassification of AKI in Cirrhotics as Hepatorenal Syndrome

Session Information

  • What Happens After AKI
    November 04, 2017 | Location: Room 295, Morial Convention Center
    Abstract Time: 04:42 PM - 04:54 PM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Velez, Juan Carlos Q., Ochsner Clinic Foundation, New Orleans, Louisiana, United States
  • Karakala, Nithin, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Huggins, John Terrill, Medical University of South Carolina, Charleston, South Carolina, United States
Background


The International Ascites Club criteria for the diagnosis of hepatorenal syndrome (HRS) requires documentation of failure to respond to 2 days of intravenous (IV) volume expansion and/or diuretic withdrawal. We hypothesized that ultrasonography (US)-based bedside techniques to assess volume status may provide clinically significant information to ascertain or disprove the clinical diagnosis of HRS.

Methods


A pilot prospective study was conducted to determine the feasibility and clinical utility of US examination of inferior vena cava (IVC) diameter and collapsibility and echocardiographic measurement of velocity time integral (VTI) to assess intravascular volume status in hospitalized adult patients with cirrhosis and acute kidney injury (AKI) who had been deemed adequately volume resuscitated and assigned a clinical diagnosis of HRS.

Results

A total of 52 patients completed the study (mean age 56.2 years, 48% women, 88% white). Mean serum creatinine (sCr) at the time of volume status assessment was 2.9 ± 1.4 mg/dL, and mean Model for End-Stage Liver Disease (MELD) score was 29.8. Twenty-two (42%) patients had an IVC diameter < 1.3 cm and were reclassified as volume depleted, 13 (25%) had an IVC diameter between 1.3 to 2 cm and 17 (33%) had an IVC > 2 cm and were reclassified as volume overloaded. Twenty-four hours later, 12 (55%) of patients reclassified as volume depleted exhibited ≥ 20% decrease in sCr along with improvement in VTI following additional IV volume expansion with ≥ 25 g/day of albumin, whereas 11 (65%) of those reclassified as volume overloaded had ≥ 20% decrease in sCr and improvement in VTI following loop diuretic therapy and/or large volume paracentesis (≥ 5 L). Altogether, 21 (40%) of patients labeled a priori as having HRS partially improved kidney function as a result of a therapeutic intervention guided by US-based volume status assessment.

Conclusion


Utilization of bedside US-based assessment of volume status in cirrhotic individuals with AKI may reduce the likelihood of incorrectly assigning a diagnosis of HRS. Further exploration of the clinical applicability of this approach is warranted.