Evolution and Survival of Cirrhotic Patients with Kidney Failure at the CHU Campus in Lomé

Abstract

Background: Renal failure in cirrhotic patients presents a significant complication that drastically affects survival rates, with factors like hepatorenal syndrome and other nephrotoxic conditions playing critical roles. Objective: To investigate the etiological and prognostic factors of renal failure in cirrhotic patients hospitalized in the Hepato-Gastroenterology department of the Lome University Hospital Center, and to assess the survival of these cirrhotic patients with renal insufficiency. Patients and Methods : Descriptive and analytical study conducted over 5 years (January 1, 2013 to December 31, 2017). Included were cirrhotic patients who had at least one serum creatinine value during hospitalization. Renal impairment was defined as a glomerular filtration rate (GFR) estimated by creatinine clearance <60 ml/min/1.73 m 2 . The statistical analysis was done with the R Studio software version 3.3.2. Results: A total of 210 patients were retained. Renal failure was found in 63 patients, with a prevalence of 30% [95% CI; 23.99% to 36.76%]. The sex ratio H/F was 0.46. The average age was 48.00 ± 14.36 years (range 18 - 95 years). Viral hepatitis B was predominant (40% of cases). Univariate and multivariate analysis showed that renal failure was associated with age > 46 years (p = 0.0035), ascites (p < 0.0001); hepatic encephalopathy stage 3 (p = 0.0091); the Child C score (p < 0.0001); arterial hypertension (p = 0.0017), hyperkalemia (p = 0.0096); and diuretics (p = 0.0039). Cirrhotic patients with renal failure required more blood transfusion than non-renal failure patients (p = 0.0047). On the seventh day of hospitalization, the probability of survival in patients with renal impairment was 0.683 [CI% 0.5690 - 0.821] versus 0.944 [CI 0.905 - 0.985] for non-renal failure patients (p < 0.0001). Conclusion: Etiologic and prognostic factors of renal failure in cirrhotic patients were age, ascites, hepatic encephalopathy stage 3, hypertension, hyperkalemia, diuretics, blood transfusion, and CHILD C. These patients have a decrease in their survival of 26.1% compared to those who do not have renal insufficiency. This makes kidney failure a prognostic factor for cirrhosis.