Renal vein dilation predicts poor outcome in patients with refractory cirrhotic ascites |
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| Authors: | Naoki Matsumoto Masahiro Ogawa Mariko Kumagawa Yukinobu Watanabe Midori Hirayama Takao Miura Hiroshi Nakagawara Shunichi Matsuoka Mitsuhiko Moriyama Hirotoshi Fujikawa |
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| Affiliation: | 1. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan;2. Department of Gastroenterology, Mitsuwadai Hospital, Chiba City, Japan;3. Department of Gastroenterology, Japan Community Health Care Organization Yokohama Chuo Hospital, Yokohama City, Japan |
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| Abstract: | ![]()
Aim Renal venous hypertension is known to be associated with worsening of renal function in patients with decompensated heart failure. Intra‐abdominal hypertension including cirrhotic ascites also leads to renal venous hypertension. We aimed to clarify the effect of renal venous hypertension on cirrhotic ascites. Methods Two hepatologists measured the left renal vein diameter in 142 consecutive patients with refractory cirrhotic ascites using non‐contrast computed tomography. The renal vein diameter was measured at the renal vein main trunk and upstream of the confluence of collateral veins. Results The inter‐observer agreements were high for the measurements of the left renal vein (r = 0.918, P < 0.001). The median overall survival for patients with renal vein diameter ≥11 mm was less than that for patients with renal vein diameter <11 mm (P < 0.001; 2.5 vs. 32.0 months). One‐year survival rates were 15.3% versus 66.4%. Multivariate analysis revealed renal vein diameter ≥11 mm (hazard ratio, 2.94; P < 0.001; 95% confidence interval, 1.67–5.20) and a high Model for End‐stage Liver Disease score combined with serum sodium level (MELD‐Na) (hazard ratio, 3.39; P < 0.001; 95% confidence interval, 2.00–5.74) were significant independent predictors of mortality. Conclusions Renal vein dilation is a risk factor of mortality in patients with refractory cirrhotic ascites, independent of the MELD‐Na score. |
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| Keywords: | ascites liver cirrhosis renal congestion renal venous hypertension |
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