Introduction:
Renal impairment significantly affects morbidity and mortality rates of cirrhosis patients. Studies on glomerular filtration rate (eGFR) estimation did not include cirrhosis patients. These equations are erroneous and unreliable in cirrhosis due to sarcopenia, malnutrition, and increased volume of distribution and interference in assays due to bilirubin. Further, the accuracy of eGFR equations varies across different ethnic groups. Measurement of GFR by Iohexol clearance is a gold standard method of accurate determination of eGFR. There is scare data on Iohexol GFR in cirrhosis and none in Indian population.
Methods:
This was prospective observational study. Consecutive adult patients with cirrhosis with stable renal function for prior 1 month were included. Iohexol weight-based dosage was given and timed blood samples were taken to measure Iohexol clearance. Plasma Iohexol levels was measured by high performance liquid chromatography (HPLC) and Cystatin-C was measured by ELISA in plasma samples.
Results:
86 patients were enrolled in the study. Hepatitis B (n=15), Hepatitis C (n=14); Alcoholic liver disease (n=44), metabolic dysfunctional associated steatotic liver disease (n=13), overlap (n=29). The average eGFR by MDRD4, MDRD6, CKD-EPI Creat, CKD EPI Cys C, CKD EPI Creat-Cys C,Grail GFR, RFH cirrhosis GFR formulae were 97.07±25.3,100.3±25.8,105.0±25.99, 72.3±20.84, 89.57±18.2, 102.3±31.5, 75.2±17.6 ml / min / 1.73m2, respectively. The average mGFR measured by Iohexol method was 69.4±16.4 ml / min / 1.73 m2. 30% agreement mGFR was found with eGFR by MDRD4 of 40.69% (n= 35), MDRD6 of 37.2%( (n= 32), CKD-EPI Creat of 26.74% (n= 23), CKD EPI Cys C of 73.25% (n= 63), CKD EPI Creat-Cys C of 76.74% (n= 66), GRAIL eGFR of 36.04% (n = 31), RFH Cirrhosis GFR of 75.58% (n= 65).
Conclusions:
The eGFR equations using creatinine are imprecise and less accurate in Indian patients with cirrhosis. All equations overestimate GFR. Equations especially developed for cirrhosis patients like MDRD6 are also not accurate. Cystatin C and Cystatin C with creatinine equations are better than creatinine alone equations. Further studies with large sample size are needed to establish an accurate method of GFR assessment in Indian patients with cirrhosis.
Pilot study has already been performed. The Abstract has been published in Journal of Clinical and Experimental Hepatology.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.