Abstract: TH-PO081
AKI Is a Rare Complication of Therapeutic Paracentesis Among Inpatients with Cirrhosis
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Sharma, Shreyak, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Seethapathy, Harish Shanthanu, Massachusetts General Hospital, Brookline, Massachusetts, United States
- Zhao, Sophia, Massachusetts General Hospital, Brookline, Massachusetts, United States
- Allegretti, Andrew S., Massachusetts General Hospital, Brookline, Massachusetts, United States
- Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background
AKI is a feared complication of therapeutic paracentesis. However, prior studies that assessed AKI incidence following paracentesis were limited by small sample sizes (most had <40 patients) and restricted generalizability (e.g., exclusion of inpatients).
Methods
We conducted a large, retrospective, “real-world” cohort study of all adult inpatients with cirrhosis who underwent a therapeutic paracentesis (>1L) while admitted to Massachusetts General Hospital between 2016 and 2018. We assessed the incidence and severity of paracentesis-associated AKI based on changes in SCr. AKI and its severity were defined based on KDIGO guidelines. We also performed stratified analyses to assess whether the incidence of AKI differed across subgroups.
Results
A total of 252 paracenteses were performed in 101 cirrhotic patients. IV albumin was administered in 77% of paracenteses. The overall incidence of AKI was 3%. AKI severity was as follows: 50% stage 1, 12.5% stage 2, and 37.5% stage 3. The incidence of AKI was similar when stratified by age (<60 vs. ≥60 years), baseline eGFR (<60 vs. ≥60 ml/min/1.73m2), and MELD score (<20 vs. ≥20). Patients who received lower compared to higher volume paracenteses (≤3L vs. >3L) had a higher incidence of AKI (6% vs. 1.3%; P=0.03), however, these patients were also less likely to have received IV albumin (65% vs. 84%; P<0.001). Patients with CHF had higher rates of AKI compared to patients without CHF (9% vs. 2.3%; P=0.03).
Conclusion
In a large cohort of inpatients with cirrhosis undergoing therapeutic paracentesis, we found that post-procedure AKI rates were low. This finding was consistent across multiple subgroups, with the notable exception of CHF. Therapeutic paracentesis with IV albumin replacement is a procedure that can generally be performed without significant concern for AKI.