European Radiology

, Volume 27, Issue 11, pp 4482–4489 | Cite as

Risk of acute kidney injury after transarterial chemoembolisation in hepatocellular carcinoma patients: A nationwide population-based cohort study

  • Bo-Ching Lee
  • Kao-Lang Liu
  • Cheng-Li Lin
  • Chia-Hung KaoEmail author
Contrast Media



This nationwide population-based cohort study evaluated the association between acute kidney injury (AKI) and transarterial chemoembolisation (TACE) in patients with hepatocellular carcinoma (HCC).


The case cohort included patients with HCC who had undergone TACE treatment between 1 January 1998 and 31 March 2010. Patients with baseline chronic kidney disease, with baseline end-stage renal disease, and aged younger than 20 years were excluded. HCC patients with TACE and HCC patients without TACE were matched 1:1 in terms of propensity scores.


A total of 1132 HCC patients with TACE and 1132 HCC patients without TACE (controls) were enrolled, of which 72 and 66 patients developed AKI, respectively. After adjustment for age, sex, comorbidity, and other medications, the risk of AKI was higher in HCC patients with TACE [hazard ratio (HR) = 1.66, 95% CI = 1.17–2.34]. The HRs of post-TACE AKI were 1.56 (95% CI = 1.02–2.37) and 1.74 (95% CI = 1.23–2.48) for patients having at least one comorbidity and less frequent sessions of TACE (≤3 times), respectively.


Our study demonstrates that TACE increases the risk of AKI in patients with HCC without chronic kidney disease or end-stage renal disease.

Key points

• Seventy-two of1132 patients with TACE and 62/1132 patients without TACE developed AKI.

• AKI risk was higher in HCC patients with TACE.

• HRs were 1.56 and 1.74 for those with comorbidities and less frequent TACE.


Acute kidney injury Transarterial chemoembolisation Hepatocellular carcinoma Nationwide population-based Cohort study 


Compliance with ethical standards


The scientific guarantor of this publication is Prof. Chia-Hung Kao.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.


This study is supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW106-TDU-B-212-113004), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037), NRPB Stroke Clinical Trial Consortium (MOST105-2325-B-039-003), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan, and Health and Welfare Surcharge of Tobacco Products, China Medical University Hospital Cancer Research Center of Excellence (MOHW105-TDU-B-212-134003, Taiwan). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

This study was approved to fulfill the condition for exemption by the Institutional Review Board (IRB) of China Medical University (CMUH-104-REC2-115-CR1).

Informed consent

Written informed consent was waived by the Institutional Review Board.


• retrospective

• observational study

• performed in the national-wide population-based database


  1. 1.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917CrossRefGoogle Scholar
  2. 2.
    El-Serag HB, Mason AC (1999) Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 340:745–750CrossRefGoogle Scholar
  3. 3.
    Altekruse SF, McGlynn KA, Reichman ME (2009) Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol 27:1485–1491CrossRefGoogle Scholar
  4. 4.
    Poon RT, Fan ST, Tsang FH, Wong J (2002) Locoregional therapies for hepatocellular carcinoma: a critical review from the surgeon's perspective. Ann Surg 235:466–486CrossRefGoogle Scholar
  5. 5.
    Bruix J, Llovet JM (2002) Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 35:519–524CrossRefGoogle Scholar
  6. 6.
    Bismuth H, Morino M, Sherlock D et al (1992) Primary treatment of hepatocellular carcinoma by arterial chemoembolization. Am J Surg 163:387–394CrossRefGoogle Scholar
  7. 7.
    Stefanini GF, Amorati P, Biselli M et al (1995) Efficacy of transarterial targeted treatments on survival of patients with hepatocellular carcinoma. an Italian experience. Cancer 75:2427–2434CrossRefGoogle Scholar
  8. 8.
    Nakoa N, Kamino K, Miura K et al (1991) Recurrent hepatocellular carcinoma after partial hepatectomy: value of treatment with transcatheter arterial chemoembolization. AJR Am J Roentgenol 156:1177–1179CrossRefGoogle Scholar
  9. 9.
    Huang YH, Chen CH, Chang TT et al (2004) The role of transcatheter arterial embolization in patients with resectable hepatocellular carcinoma: a nation-wide, multicenter study. Liver Int 24:419–424CrossRefGoogle Scholar
  10. 10.
    Aspelin P, Aubry P, Fransson SG et al (2003) Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 348:491–499CrossRefGoogle Scholar
  11. 11.
    Barrett BJ, Parfrey PS (2006) Clinical practice. preventing nephropathy induced by contrast medium. N Engl J Med 354:379–386CrossRefGoogle Scholar
  12. 12.
    Choi H, Kim Y, Kim SM et al (2012) Intravenous albumin for the prevention of contrast-induced nephropathy in patients with liver cirrhosis and chronic kidney disease undergoing contrast-enhanced CT. Kidney Res Clin Pract 31:106–111CrossRefGoogle Scholar
  13. 13.
    Huo TI, Wu JC, Huang YH et al (2004) Acute renal failure after transarterial chemoembolization for hepatocellular carcinoma: a retrospective study of the incidence, risk factors, clinical course and long-term outcome. Aliment Pharmacol Ther 19:999–1007CrossRefGoogle Scholar
  14. 14.
    Hsu CY, Huang YH, Su CW et al (2010) Renal failure in patients with hepatocellular carcinoma and ascites undergoing transarterial chemoembolization. Liver Int 30:77–84CrossRefGoogle Scholar
  15. 15.
    Huo TI, Wu JC, Lee PC, Chang FY, Lee SD (2004) Incidence and risk factors for acute renal failure in patients with hepatocellular carcinoma undergoing transarterial chemoembolization: a prospective study. Liver Int 24:210–215CrossRefGoogle Scholar
  16. 16.
    Zhou C, Wang R, Ding Y et al (2014) Prognostic factors for acute kidney injury following transarterial chemoembolization in patients with hepatocellular carcinoma. Int J Clin Exp Pathol 7:2579–2586PubMedPubMedCentralGoogle Scholar
  17. 17.
    Cheng CL, Kao YH, Lin SJ, Lee CH, Lai ML (2011) Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan. Pharmacoepidemiol Drug Saf 20:236–242CrossRefGoogle Scholar
  18. 18.
    Parsons L (2001) Performing a 1: N case–control match on propensity score. SUGI 29Google Scholar
  19. 19.
    Persson PB, Hansell P, Liss P (2005) Pathophysiology of contrast medium-induced nephropathy. Kidney Int 68:14–22CrossRefGoogle Scholar
  20. 20.
    Perazella MA (2012) Onco-nephrology: renal toxicities of chemotherapeutic agents. Clin J Am Soc Nephrol 7:1713–1721CrossRefGoogle Scholar
  21. 21.
    Uchino S, Kellum JA, Bellomo R et al (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818CrossRefGoogle Scholar
  22. 22.
    Wald R, Quinn RR, Luo J et al (2009) Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA 302:1179–1185CrossRefGoogle Scholar
  23. 23.
    Coca SG, Singanamala S, Parikh CR (2012) Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 81:442–448CrossRefGoogle Scholar
  24. 24.
    Lo CM, Ngan H, Tso WK et al (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35:1164–1171CrossRefGoogle Scholar
  25. 25.
    Llovet JM, Real MI, Montana X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359:1734–1739CrossRefGoogle Scholar
  26. 26.
    Lodhia N, Kader M, Mayes T, Mantry P, Maliakkal B (2009) Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis. World J Gastroenterol 15:1459–1464CrossRefGoogle Scholar
  27. 27.
    Moreau R, Lebrec D (2003) Acute renal failure in patients with cirrhosis: perspectives in the age of MELD. Hepatology 37:233–243CrossRefGoogle Scholar
  28. 28.
    Chang FC, Lirng JF, Luo CB et al (2008) Patients with head and neck cancers and associated postirradiated carotid blowout syndrome: endovascular therapeutic methods and outcomes. J Vasc Surg 47:936–945CrossRefGoogle Scholar
  29. 29.
    Hayakawa K, Tanikake M, Kirishima T et al (2014) The incidence of contrast-induced nephropathy (CIN) following transarterial chemoembolisation (TACE) in patients with hepatocellular carcinoma (HCC). Eur Radiol 24:1105–1111CrossRefGoogle Scholar
  30. 30.
    Lammer J, Malagari K, Vogl T et al (2010) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33:41–52CrossRefGoogle Scholar
  31. 31.
    Vogl TJ, Lammer J, Lencioni R et al (2011) Liver, gastrointestinal, and cardiac toxicity in intermediate hepatocellular carcinoma treated with PRECISION TACE with drug-eluting beads: results from the PRECISION V randomized trial. AJR Am J Roentgenol 197:W562–W570CrossRefGoogle Scholar
  32. 32.
    Oliveri RS, Wetterslev J, Gluud C (2011) Transarterial (chemo)embolisation for unresectable hepatocellular carcinoma. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD004787.pub2:CD004787 CrossRefPubMedGoogle Scholar
  33. 33.
    Golfieri R, Giampalma E, Renzulli M et al (2014) Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. Br J Cancer 111:255–264CrossRefGoogle Scholar
  34. 34.
    Waikar SS, Wald R, Chertow GM et al (2006) Validity of International classification of diseases, ninth revision, clinical modification codes for acute renal failure. J Am Soc Nephrol 17:1688–1694CrossRefGoogle Scholar
  35. 35.
    Lameire N (2014) Nephrotoxicity of recent anti-cancer agents. Clin Kidney J 7:11–22CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Bo-Ching Lee
    • 1
  • Kao-Lang Liu
    • 1
  • Cheng-Li Lin
    • 2
    • 3
  • Chia-Hung Kao
    • 4
    • 5
    • 6
    Email author
  1. 1.Department of Medical ImagingNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
  2. 2.School of Medicine, College of MedicineChina Medical UniversityTaichungTaiwan
  3. 3.Management Office for Health DataChina Medical University HospitalTaichungTaiwan
  4. 4.Graduate Institute of Clinical Medical Science and School of Medicine, College of MedicineChina Medical UniversityTaichungRepublic of China
  5. 5.Department of Nuclear Medicine and PET CentreChina Medical University HospitalTaichungTaiwan
  6. 6.Department of Bioinformatics and Medical EngineeringAsia UniversityTaichungTaiwan

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