Kidney Week

Abstract: TH-PO1087

Proximal Tubular Secretory Clearance Is Preserved in Cirrhosis

Session Information

• CKD Progression and Complications: Diagnosis, Prognosis, Risk Factors
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Granda, Michael L., University of Washington, Seattle, Washington, United States

Michael L. Granda,

• Luitweiler, Eric, University of Washington, Seattle, Washington, United States

Eric Luitweiler,

• Paine, Cary H., University of Washington, Seattle, Washington, United States

Cary H. Paine,

• Pichler, Raimund T. H., University of Washington, Seattle, Washington, United States

Raimund T. H. Pichler,

• Sibulesky, Lena, University of Washington, Seattle, Washington, United States

Lena Sibulesky,

• Kestenbaum, Bryan R., University of Washington, Seattle, Washington, United States

Bryan R. Kestenbaum,

Background

Cirrhosis promotes substantial changes in the metabolic and circulatory milieu, leading to vasoconstriction of the kidney arterioles and a consequent reduction in the glomerular filtration rate (GFR). Liver disease further leads to the retention of toxic metabolites that may impair proximal tubular functions. We tested whether cirrhosis is associated with alterations in tubular secretory clearance in patients referred for liver transplantation.

Methods

We recruited 39 outpatients with end stage liver disease undergoing workup for transplantation. We selected 58 control subjects without liver disease, matched to patients with cirrhosis by their estimated GFR (±10 ml/min/1.73m²). We estimated tubular secretory solute clearance based on 24-hour urine and plasma concentrations of endogenous solutes measured by LC/MS. We determined the mean fold-difference of secretory clearance using regression of log-transformed clearances and adjusted for eGFR, age, and sex.

Results

Cirrhosis patients were characterized by a mean Child-Pugh 7.9±1.8 or moderate (B) liver disease, 72% male, age 57 ±9 years, and eGFR 65.6 ±19.7 ml/min/1.73m². Tubular secretory clearances of most endogenous solutes was equal to or higher in patients with cirrhosis compared to control persons (Fig. 1), which persisted after adjustment for eGFR, age, and sex (Tab. 1). The plasma concentrations of many solutes were substantially lower in cirrhosis (Fig. 2).

Conclusion

In contrast to our hypothesis, proximal tubular secretory clearance is largely preserved or increased in outpatients with cirrhosis. Cirrhosis patients had substantially lower plasma levels of many solutes despite similar kidney function.

Funding

• NIDDK Support