Journal Article

Pitfalls in assessing renal function in patients with cirrhosis—potential inequity for access to treatment of hepatorenal failure and liver transplantation

Andrew Davenport, Evangelos Cholongitas, Elias Xirouchakis and Andrew Kenneth Burroughs

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 9, pages 2735-2742
Published in print September 2011 | ISSN: 0931-0509
Published online June 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfr354
Pitfalls in assessing renal function in patients with cirrhosis—potential inequity for access to treatment of hepatorenal failure and liver transplantation

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Serum creatinine is universally used to assess renal function in clinical practice. Creatinine and changes in serum creatinine are used to define acute kidney injury and hepatorenal syndrome (HRS) in patients with progressive liver disease. In addition, creatinine is a key variable in the calculation used to determine priority for liver transplantation in many countries. As there is no universal standardized creatinine assay, there is variation in creatinine determinations between laboratory assays, compounded by assay interference due to chromogens, including bilirubin. This leads to patients with the same actual renal function potentially being offered different treatment options, in terms of access to therapy for HRS and priority waiting time for liver transplantation. Alternative methods for assessing renal function either also tend to overestimate renal function or are too time consuming and expensive to provide practical alternatives for standard clinical practice. Standardization of creatinine assays with readily available reference standards would help minimize interlaboratory variation; of the current creatinine assays, enzymatic creatinine appears more accurate, but even this is inaccurate at high bilirubin concentrations. Further work is required to determine whether interpatient variation can be reduced by correcting creatinine and cystatin measurements for muscle mass.

Keywords: chronic liver disease; cirrhosis; cystatin C; GFR; renal function creatinine

Journal Article.  5597 words.  Illustrated.

Subjects: Nephrology

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