Serum sodium, renal function, and survival of patients with end-stage liver disease

Young Suk Lim, Timothy S. Larson, Joanne T. Benson, Patrick Sequeira Kamath, Walter K Kremers, Terry M Therneau, W. Ray Kim

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background & Aims: Serum creatinine, a component of the model for end-stage liver disease (MELD), is an important prognostic indicator in patients with end-stage liver disease (ESLD). In addition, serum sodium has recently been recognized as an important predictor of mortality in patients with ESLD. We investigate the role of serum creatinine and sodium, and glomerular filtration rate (GFR) as determinants of survival in patients with ESLD. Methods: A prospective database was utilized to identify all adults listed for primary liver transplantation (LTx) at the Mayo Clinic, Rochester, between 1990 and 1999. GFR was measured by iothalamate clearance. Results: Among 837 patients listed for LTx, 660 had complete data including measured GFR. There was a significant association between GFR and survival after adjustment for MELD, with a linear rise in the risk of death as GFR decreased between 60 and 20 ml/min/1.73 m 2. Multivariable models showed that GFR is superior to creatinine in predicting mortality - a model consisting of total bilirubin (hazard ratio (HR) = 2.17, p < 0.01), INR (HR = 3.26, p < 0.01) and GFR (HR = 0.42, p < 0.01) was superior to MELD (chi-square 65.6 vs. 59.4, c-statistic 0.792 vs. 0.780). Serum sodium did not contribute to survival prediction when accurately measured GFR data were available. Conclusions: Serum concentrations of creatinine and sodium in patients with end-stage liver disease reflect a reduction in renal function, the underlying event that decreases survival.

Original languageEnglish (US)
Pages (from-to)523-528
Number of pages6
JournalJournal of Hepatology
Volume52
Issue number4
DOIs
StatePublished - Apr 2010

Fingerprint

End Stage Liver Disease
Glomerular Filtration Rate
Sodium
Kidney
Survival
Serum
Creatinine
Iothalamic Acid
International Normalized Ratio
Mortality
Bilirubin
Liver Transplantation
Databases

Keywords

  • Glomerular filtration rate
  • Liver cirrhosis
  • MELD
  • Prognosis

ASJC Scopus subject areas

  • Hepatology

Cite this

Serum sodium, renal function, and survival of patients with end-stage liver disease. / Lim, Young Suk; Larson, Timothy S.; Benson, Joanne T.; Kamath, Patrick Sequeira; Kremers, Walter K; Therneau, Terry M; Kim, W. Ray.

In: Journal of Hepatology, Vol. 52, No. 4, 04.2010, p. 523-528.

Research output: Contribution to journalArticle

Lim, Young Suk ; Larson, Timothy S. ; Benson, Joanne T. ; Kamath, Patrick Sequeira ; Kremers, Walter K ; Therneau, Terry M ; Kim, W. Ray. / Serum sodium, renal function, and survival of patients with end-stage liver disease. In: Journal of Hepatology. 2010 ; Vol. 52, No. 4. pp. 523-528.
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N2 - Background & Aims: Serum creatinine, a component of the model for end-stage liver disease (MELD), is an important prognostic indicator in patients with end-stage liver disease (ESLD). In addition, serum sodium has recently been recognized as an important predictor of mortality in patients with ESLD. We investigate the role of serum creatinine and sodium, and glomerular filtration rate (GFR) as determinants of survival in patients with ESLD. Methods: A prospective database was utilized to identify all adults listed for primary liver transplantation (LTx) at the Mayo Clinic, Rochester, between 1990 and 1999. GFR was measured by iothalamate clearance. Results: Among 837 patients listed for LTx, 660 had complete data including measured GFR. There was a significant association between GFR and survival after adjustment for MELD, with a linear rise in the risk of death as GFR decreased between 60 and 20 ml/min/1.73 m 2. Multivariable models showed that GFR is superior to creatinine in predicting mortality - a model consisting of total bilirubin (hazard ratio (HR) = 2.17, p < 0.01), INR (HR = 3.26, p < 0.01) and GFR (HR = 0.42, p < 0.01) was superior to MELD (chi-square 65.6 vs. 59.4, c-statistic 0.792 vs. 0.780). Serum sodium did not contribute to survival prediction when accurately measured GFR data were available. Conclusions: Serum concentrations of creatinine and sodium in patients with end-stage liver disease reflect a reduction in renal function, the underlying event that decreases survival.

AB - Background & Aims: Serum creatinine, a component of the model for end-stage liver disease (MELD), is an important prognostic indicator in patients with end-stage liver disease (ESLD). In addition, serum sodium has recently been recognized as an important predictor of mortality in patients with ESLD. We investigate the role of serum creatinine and sodium, and glomerular filtration rate (GFR) as determinants of survival in patients with ESLD. Methods: A prospective database was utilized to identify all adults listed for primary liver transplantation (LTx) at the Mayo Clinic, Rochester, between 1990 and 1999. GFR was measured by iothalamate clearance. Results: Among 837 patients listed for LTx, 660 had complete data including measured GFR. There was a significant association between GFR and survival after adjustment for MELD, with a linear rise in the risk of death as GFR decreased between 60 and 20 ml/min/1.73 m 2. Multivariable models showed that GFR is superior to creatinine in predicting mortality - a model consisting of total bilirubin (hazard ratio (HR) = 2.17, p < 0.01), INR (HR = 3.26, p < 0.01) and GFR (HR = 0.42, p < 0.01) was superior to MELD (chi-square 65.6 vs. 59.4, c-statistic 0.792 vs. 0.780). Serum sodium did not contribute to survival prediction when accurately measured GFR data were available. Conclusions: Serum concentrations of creatinine and sodium in patients with end-stage liver disease reflect a reduction in renal function, the underlying event that decreases survival.

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