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Gender-Specific Differences in Baseline, Peak, and Delta Serum Creatinine: The NACSELD Experience

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Abstract

Background

Women have lower serum creatinine values than men for similar renal function.

Aims

We aimed to determine the differential effect of baseline, peak, and delta creatinine between genders on outcomes in infected hospitalized cirrhotic patients.

Methods

North American Consortium for the Study of End-Stage Liver Disease is a 15-center consortium of tertiary care hepatology centers prospectively enrolling infected cirrhotic inpatients. Baseline, peak, and delta creatinine during hospitalization were compared between genders, and their impact on overall survival, transplant-free survival, probability of transplantation, and need for renal replacement therapy (RRT) was analyzed.

Results

In total, 532 patients with cirrhosis (males = 59% median admission MELD = 20) had significantly lower median baseline (1.07 vs. 1.30 mg/dL, p < 0.0001) and peak creatinine (1.47 vs. 1.59 mg/dL, p = 0.024) in women than men during hospitalization for an infection, but both genders had similar delta creatinine levels (0.30 vs. 0.30 mg/dL, p = 0.957). Thirty-day mortality was similar between genders. RRT was not used more often in women (19 vs. 12%, p = 0.050), and women were 1.8 times more likely than men to receive RRT at the same creatinine (p = 0.028). Both peak and delta creatinine significantly predicted 6-month overall and transplant-free survival (p < 0.0001), but the probability of liver transplantation was affected by the interaction between gender and both peak and delta creatinine.

Conclusions

Infected hospitalized cirrhotic women are significantly more likely than men to receive RRT at similar creatinine levels. Gender-specific differences in baseline, peak, and delta creatinine need further investigation to determine whether women need acute kidney injury treatment at lower creatinine thresholds than men.

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Abbreviations

ACLF:

Acute-on-chronic liver failure

AKI:

Acute kidney injury

AKIN:

Acute kidney injury network

CC:

Cryptogenic cirrhosis

ETOH:

Alcohol

GFR:

Glomerular filtration rate

HCV:

Hepatitis C

HRS:

Hepatorenal syndrome

INR:

International normalized ratio

IQR:

Interquartile range

KDIGO:

Kidney Disease Improving Global Outcomes

MELD:

Model for end-stage liver disease

MRSA:

Methicillin-resistant staph aureus

NA:

Not applicable

NACSELD:

North American Consortium for the Study of End-Stage Liver Disease

NASH:

Nonalcoholic steatohepatitis

OR:

Odds ratio

REDCap:

Research Electronic Data Capture

RIFLE:

Risk, injury, failure, loss of kidney function and end-stage kidney disease

RRT:

Renal replacement therapy

SBP:

Spontaneous bacterial peritonitis

SD:

Standard deviation

UTI:

Urinary tract infection

VRE:

Vancomycin-resistant enterococcus

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Author information

Authors and Affiliations

  1. Division of Hepatology, Baylor Simmons Transplant Institute, Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, 3410 Worth St, Suite 860, Dallas, TX, 75246, USA

    Jacqueline G. O’Leary

  2. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Florence Wong

  3. Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    K. Rajender Reddy

  4. Department of Medicine, Yale University, New Haven, CT, USA

    Guadalupe Garcia-Tsao

  5. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Patrick S. Kamath

  6. Department of Medicine, University of Colorado Denver, Denver, CO, USA

    Scott W. Biggins

  7. Department of Medicine, University of Texas Health Science Center, Houston, TX, USA

    Michael B. Fallon

  8. Department of Medicine, Emory University, Atlanta, GA, USA

    Ram M. Subramanian

  9. Department of Medicine, University of Rochester, Rochester, NY, USA

    B. Maliakkal

  10. Department of Medicine, Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA

    Leroy Thacker & Jasmohan S. Bajaj

  11. McGuire VA Medical Center, Richmond, VA, USA

    Jasmohan S. Bajaj

Authors
  1. Jacqueline G. O’Leary
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  2. Florence Wong
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  3. K. Rajender Reddy
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  4. Guadalupe Garcia-Tsao
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  5. Patrick S. Kamath
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  6. Scott W. Biggins
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  7. Michael B. Fallon
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  11. Jasmohan S. Bajaj
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Corresponding author

Correspondence to Jacqueline G. O’Leary.

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O’Leary, J.G., Wong, F., Reddy, K.R. et al. Gender-Specific Differences in Baseline, Peak, and Delta Serum Creatinine: The NACSELD Experience. Dig Dis Sci 62, 768–776 (2017). https://doi.org/10.1007/s10620-016-4416-7

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  • DOI: https://doi.org/10.1007/s10620-016-4416-7

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