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Kidney Week

Abstract: FR-PO005

Impact of Porto-Pulmonary Hypertension in the Course of Hepatorenal AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Rivera, Maria Soledad, Ochsner Clinic Foundation, New Orleans, Louisiana, United States
  • Mohammed, Alaa E., Ochsner Clinic Foundation, New Orleans, Louisiana, United States
  • Velez, Juan Carlos Q., Ochsner Clinic Foundation, New Orleans, Louisiana, United States
Background

Porto-pulmonary hypertension is prevalent in cirrhotic patients. However, its impact on the clinical course of hepatorenal acute kidney injury (AKI) has not been previously investigated. We hypothesized that echocardiographic evidence of pulmonary hypertension affects the interplay between change in mean arterial pressure (MAP) and course of hepatorenal AKI during vasoconstrictor therapy as well as the overall renal outcome.

Methods

We conducted a prospective observational study of hospitalized patients with AKI stage ≥ 2 (AKIN) and cirrhosis over a 4-month period. Daily MAP and serum creatinine (sCr) values were collected, as well as pulmonary arterial pressure (PAP) estimated by echocardiography at the time of AKI. Patients were divided into PAP tertiles: 1st ≤30, 2nd 31-40, 3rd >40 mmHg. Daily change in MAP (ΔMAP) and daily change in sCr (ΔsCr) from baseline were computed. Renal outcome chosen was need for renal replacement therapy (RRT).

Results

Among 52 patients, 19 (37%) were female, mean age was 56 (range 25-75). Baseline values were median MAP 76 (IQR 71–84) mmHg, median sCr 2.3 (IQR 1.7–3.7) mg/dL, median serum albumin 2.3 (IQR 1.8–3) g/dL and median total bilirubin 4.1 (IQR 1.8–27.2) mg/dL. A significant inverse correlation was found between ΔMAP and ΔsCr on the following day (r = -0.20, p=0.0003) throughout the course of AKI. PAP was obtained in 36 patients. The correlation between ΔMAP and ΔsCr within each PAP tertile were: ≤30: r = 0.08 (p=0.37), 31-40: r = -0.36 (p=0.002) and >40: r = -0.40 (p=0.0006). Thus, as PAP increases, a negative correlation between ΔMAP and ΔsCr on the following day strengthens. Furthermore, there was a trend for an increased need for RRT within those in the highest tertile of PAP (need for RRT: 28.6%, 33%, and 70%, for the 1st, 2nd, and 3rd tertiles, respectively (p=0.0511, chi-square for trend).

Conclusion

Cirrhotic patients with more severe pulmonary hypertension exhibit a significantly stronger negative correlation between ΔMAP and ΔsCr, suggesting that those with higher PAP may display increased sensitivity to improved kidney function upon optimization of MAP with vasoconstrictors. Moreover, higher PAP is associated with greater need for RRT, adding complexity to the pathogenesis of hepatorenal AKI.