How to estimate renal function in patients with liver disease: choosing the most suitable equation
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Hepatitis B virus (HBV) infection is a public health challenge, especially in China. In clinical practice, HBV infection is associated with nephropathy. Impaired renal function is frequently observed in compensated Chronic Hepatitis B (CHB) and cirrhosis (LC). Thus, renal function must be monitored to avoid nephrotoxic effects before and during nucleoside analog treatment. Investigating the predictive markers of early renal dysfunction is essential. New GFR-predicting equations, based on Pcr and/or CystC, have been recently recommended in the general population, but their performance in liver disease patients has been rarely studied. In this study, we will discuss how to detect renal dysfunction in patients with HBV infection.
A total of 16 LC patients and 23 CHB patients were enrolled in this study, and we collected and compared the clinical data of the two groups. The estimated glomerular filtration rates (eGFRs) were also calculated by several equations. All patients received 99mTc-DTPA dynamic radionuclide imaging examinations to obtain mGFRs as the reference standard. To evaluate the performance of any equation in the CHB and LC groups, paired t test, Pearson’s correlation, Kappa analysis and Bland–Altman plots were utilized. Moreover, all 39 subjects were divided into two groups (according to GFR > 90 mL/min/1.73 m2). We compared the serum and urinary markers of kidney injury between the two groups and selected the indicators of renal injury by univariate analysis.
The mGFR was 72.26 ± 20.69 mL/min/1.73 m2 in the LC group, and 87.49 ± 25.91 mL/min/1.73 m2 in the CHB group. The paired t test results of eGFR and mGFR showed no difference between eGFR (estimated by the CHINAcr-cys equation) and mGFR (p > 0.05) in the compensated LC and CHB groups. The difference between mGFR and eGFR estimated by other methods was obvious (p < 0.05). Comparing the eGFRs (estimated by 5 different equations) with mGFR in the compensated LC and CHB groups, Pearson’s correlation showed that only eGFR (estimated by the CHINAcr-cys equation) had a significant correlation coefficient in CHB (r = 0.678, p = 0.000) and had the highest R2 (R2 = 0.459) among all other measures. The kappa consistency test showed that eGFR from CHINAscr-cys had poor consistency with mGFR in the compensated LC group but moderate consistency in the CHB group. Bland–Altman consistency analysis showed that in the CHB group, the CHINAcr-cys and CKD-EPIcr equations presented narrower acceptable limits than did the aMDRD, c-aMDRD, and CKD-EPIcr-cys equations (62.8, 56.1 vs .85.7, 102.9, 93.6 mL/min per 1.73 m2). In the compensated LC group, the CHINAcr-cys and CKD-EPIcr equations presented narrower acceptable limits than did the aMDRD, c-aMDRD, and CKD-EPIcr-cys equations (83.6, 81.3 vs. 98, 113.5, 106.3 mL/min per 1.73 m2). Serum or urinary markers were compared with renal function (GFR > 90 mL/min/1.73 m2) and showed International normalized ratio (INR) (p = 0.009), creatinine (p = 0.006), urine N-acetyl-β-glucosaminidase (NAG) (p = 0.001) and serum cystatin C (CysC) (p = 0.044).
The CHINAcr-cys equation may be more suitable for the estimation of GFR in Chinese patients with CHB or compensated cirrhosis. INR, creatinine, NAG, and CysC are proper biomarkers for screening renal dysfunction in Chinese patients with CHB or compensated LC.
KeywordsHepatitis B virus Hepatic fibrosis Renal injury Glomerular filtration rate
Supported by the National Science and Technology Major Project (2016ZX10002011).
SR, LZ and HL provided the ideas, and SR, HL and YC drafted the report. YC, QZ, XW, HN, LC, CL, ZZ and XX delivered experimental data. All authors have read and contributed to editing this manuscript and agree with the content and presentation of the paper.
Compliance with ethical standards
Conflict of interest
No conflicts of interest, financial or otherwise, are declared by the authors.
- 3.Liu Y, Fan R, Chen J, Zheng Z, Liao B, Liang X, Yin J, Zhou Q, Sun J (2014) Assessment of renal function and risk factors for renal impairment in patients with hepatitis B virus-related liver cirrhosis. J South Med Univ 34(4):472–476Google Scholar
- 5.Hai LI, Han T, Yan LI, Chen LY, Wang YL, Xiang XH, Yang SG, Zhu LM (2015) The early renal injury and its related factors in patients with chronic HBV infection. Chin J Blood Purif 0(11):644–648Google Scholar
- 9.Levey AS, Green T, Kuseket J, Beck G (2000) A simplified equitation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol 11:A0828Google Scholar
- 17.Tent H, Rook M, Stevens LA, Son WJV, Pelt LJV, Hofker HS, Ploeg RJ, Heide JJHVD, Navis G (2010) Renal function equations before and after living kidney donation: a within-individual comparison of performance at different levels of renal function. Clin J Am Soc Nephrol 5(11):1960–1968CrossRefGoogle Scholar
- 21.Guo X, Qin Y, Zheng K, Gong M, Wu J, Shou W, Cheng X, Xia L, Xu E, Li X (2014) Improved glomerular filtration rate estimation using New equations combined with standardized cystatin C and creatinine in Chinese adult chronic kidney disease patients. Clin Biochem 47(13–14):1220–1226CrossRefGoogle Scholar
- 28.Uslu S, Efe B, Alataş O, Kebapçi N, Colak O, Demirüstü C, Yörük A (2005) Serum cystatin C and urinary enzymes as screening markers of renal dysfunction in diabetic patients. J Nephrol 18(5):559–567Google Scholar
- 30.Omar M, Abdelrazek W, Aboraia G, Assem M, Elazab G (2015) Evaluation of serum cystatin C as a marker of early renal impairment in patients with liver cirrhosis. Int J Hepatol 2015:Article ID 309042Google Scholar