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