Evaluation of renal function in patients with cirrhosis: Where are we now?

Abstract

In the clinical context of the patients with liver cirrhosis, accurate evaluation of the renal function is potentially crucial. Indeed, it can lead to early diagnosis of both acute kidney injury and chronic kidney disease and to reliable characterization of the renal status of the patient before performing a liver transplantation. Despite some limitations, the assay of serum creatinine (SCr) is universally used to estimate glomerular filtration rate (GFR) because of its wide availability, its simplicity and because it is inexpensive. Nevertheless, several reports show that the value of this assay to estimate GFR is strongly challenged in cirrhotic patients, especially in patients with liver failure and/or severely impaired renal function. This has led to seek new alternatives to estimate more reliably the GFR in these patients. Although the reference methods, based on the utilization of exogenous markers, allow measuring GFR and thereby constitute the “gold standard” to evaluate renal function, they are not feasible in routine clinical practice. Several studies have shown that a cystatin C (CysC) based formula perform better than the SCr-based estimates in cirrhotic patients and the estimation of GFR by these formulas could therefore lead to optimize the management of the patients. A new estimate based on CysC has been recently developed using a large number of patients and the first results regarding the evaluation of its performance are promising, making this new formula the best candidate for a reference estimate of the renal function in cirrhotic patients.

Keywords: Cirrhosis, Glomerular filtration rate, Formula, Estimation, Agreement, Plasma creatinine, Cystatin C

Core tip: Cirrhotic patient management frequently requires evaluation of renal function. However, these patients present some specific disturbances that affect the serum creatinine value, making its use to estimate glomerular filtration rate unsuitable. To get a more appropriate evaluation of the glomerular filtration rate, other methods are available such as the use of exogenous markers or assaying cystatin C in the blood, which avoid the drawbacks of the serum creatinine. Recently, a convenient new cystatin C based formula was tested and showed correct performance in cirrhotic patients, even in case of liver failure and/or severely decrease renal function.