Research Papers:

The prevalence and association of chronic kidney disease and diabetes in liver cirrhosis using different estimated glomerular filtration rate equation

Cheng-Yi Chen, Cheng-Jui Lin, Chih-Sheng Lin, Fang-Ju Sun, Chi-Feng Pan, Han-Hsiang Chen and Chih-Jen Wu _

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Oncotarget. 2018; 9:2236-2248. https://doi.org/10.18632/oncotarget.23368

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Cheng-Yi Chen1,2,3, Cheng-Jui Lin2,4,5, Chih-Sheng Lin3, Fang-Ju Sun2,6, Chi-Feng Pan2,4, Han-Hsiang Chen2,4 and Chih-Jen Wu4,5,7,8

1Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Hsinchu, Taiwan

2MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan

3Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan

4Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan

5Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

6Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan

7Graduate Institute of Medical Sciences and Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

8Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan

Correspondence to:

Chih-Jen Wu, email: [email protected]

Keywords: liver cirrhosis; chronic kidney disease; diabetes mellitus; estimated glomerular filtration rate; MELD score

Received: June 02, 2017     Accepted: August 29, 2017     Published: December 18, 2017


Background: Chronic kidney disease (CKD) in cirrhosis is one of the dreaded complications associated with a steep rise in mortality and morbidity, including diabetes. There are limited data on the prevalence of CKD and the association with diabetes in outpatients with cirrhosis.

Methodology: This is a cross-sectional study of 7,440 adult liver cirrhosis patients enrolled from August 2001 to April 2010 in a medical center. Case control matching by age and sex with 1,967 pairs, and conditional logistic regression for odds of diabetes was analyzed using adjusted model.

Results: CKD was present in 46.0%, 45.7% and 45.6% of the study population using the MDRD-6, CKD-EPI and MDRD-4 estimated glomerular filtration rate (eGFR) equations, respectively. Using a conditional logistic regression model after adjusting for other risk factors, odds for diabetes increased significantly compared with non-CKD in CKD stage 3 to 5 (stage 3~5) based on MDRD-6–adjusted model, ORs were: stage 3~5, 2.34 (95% CI, 1.78-3.01); MDRD-4–adjusted model, ORs were: stage 3~5, 8.51 (95% CI, 5.63-11.4); CKD-EPI–adjusted model, ORs were: stage 3~5, 8.61 (95% CI, 5.13-13.9).

Conclusion: In cirrhosis patients, prevalence of diabetes was higher in patients with advanced stage of CKD. For patients with cirrhosis, patients with CKD stages 3~5 defined by MDRD-4, MDRD-6, and CKD-EPI eGFR equations had increased risk for diabetes. More severe cirrhosis, indicated by the Child-Turcott-Pugh classification was also accompanied by an increased risk for diabetes.

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