A study of renal function, serum sodium and their impact on survival of patients with end stage liver disease

Background: Serum creatinine is considered to reflect renal function; however, it is not a very accurate gauge, especially in detecting early loss of renal function. To estimate the role of serum creatinine, sodium, and estimated glomerular filtration rate (eGFR) as determinants of survival in patients with End stage liver disease (CTP-C). Methods: Patients with decompensated cirrhosis (CTP-C) and serum creatinine ≤ 1.5 mg/dl were included in the study. Patients with Diabetes, Hypertension, Post-transplant candidates were excluded. MELD was calculated by MELD Score. MELD Na was calculated by MELD-Na = MELD +1.59 (135 - Na).eGFR was calculated by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula. The primary event of interest in this study was death within 6 months. Results: Total 64 patients were included in the study. 30(46.8%) were having alcohol, 19 (29.6%) patients had viral etiology as the cause of cirrhosis. Out of 64 patients, 18 patients (28.12%) died during 6 months follow up. Hyponatremia was present in 61.1% of dead patients and 21.7% of survived patients. eGFR was ≥90ml/min/1.73m2 in 12 patients, 16% died. eGFR was 60-89 ml/min/1.73m2in 32 patients,25% died and eGFR was <60 ml/min/1.73m2in 20 patients, 40% died. Univariate Analysis of Baseline Variables showed serum creatinine had no significance in the survival of patients with end stage liver disease (CTP-C). MELD score, eGFR, serum sodium and MELD-Na had significance in the survival. Multivariate Cox Regression Summaries for MELD, Hyponatremia, and MELD plus Serum Sodium in Predicting Death Considering 6-Month Follow-Up Data showed c-Static for MELD is 0.75 where as c-Static for MELD-Na is 0.805 and for a model comprising bilirubin, INR, eGFR and sodium is 0.816. Conclusions: When compared to serum creatinine, eGFR is a better tool for estimating survival of patients with ESLD. As eGFR decreases the percentage of mortality increases.