- Email: [email protected]
Aquaporin-2 in Cirrhosis: Relation to Disease Severity, Markers of Renal Function and Impact on Development of Renal Insufficiency and Mortality
POSTER PRESENTATIONS Methods: 21 consecutive cirrhotic patients with refractory ascites were admitted to our day care for LVP. Systemic hemodynamic parameters and neurohumoral factors were monitored and compared before and after LVP, with and without the administration of albumin, and with/without β-blockers using the NICAS system. The mean arterial pressure, cardiac output index, stroke volume (SV), and total systemic vascular resistance index were assessed as well as the plasma renin, aldosterone, noradrenaline and BNP (brain natriuretic factor) levels. Results: Mean volume of ascites fluid removed was 6.0 +/− 3.2 L. In 9 patients, albumin (8g per liter of ascitic fluid removed) was administered. A significant decrease in mean arterial pressure (−5 mm Hg; p = 0.01) and in total peripheral vascular resistance index -200 dyne·sec/cm5 m2; p = 0.001) was noted post LVP. Four different types of systemic hemodynamic changes were noted after LVP: 1. A significant reduction in total peripheral resistance (TPR) and mean arterial pressure (7 patients/33%) accompanied by increase in cardiac output index. 2. Reduction in stroke volume inducing a reduction in mean arterial pressure but no accompanied significant reduction in TPR (5 patients/24%). 3. A favorable response expressed as an increase in cardiac output index, and mean arterial pressure without effect on TPR (5 patients/24%). 4. No change in systemic hemodynamics parameters (4 patients/19%). The effect of β-blockers administration and changes in plasma renin, noradrenalin, aldosteron and BNP will be presented. Conclusions: LVP-induced systemic hemodynamic changes can be monitored noninvasively by the NICAS system in cirrhotic patients with refractory ascites. The individual hemodynamic changes observed following LVP can be further used for response-guided therapy such as albumin, β-blockers or terlipressin.
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Department of Hepatogastroenterology, Institute for Clinical and Experimental, Prague, Czech Republic; 8Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands E-mail: [email protected] Background and Aims: In cirrhosis, renal failure is a serious complication with a high mortality in particular in patients who develop hepatorenal syndrome (HRS). Several methods for the assessment of renal function have been introduced within the last decades but in daily clinical practice, serum creatinine is the most frequently used measure for glomerular filtration rate (GFR). However, serum creatinine is an inaccurate marker of GFR in cirrhosis because of muscle wasting and increased renal excretion of creatinine in cirrhosis. There is therefore a need for alternative markers of renal function that are easy accessible. Aquaporin 2 (AQP2) is a measure of water channel transport in the principal cells in the distal part of the nephron and thought to be involved in water retention in cirrhosis. This has turned out be a promised biochemical marker of renal function. In this study, we aimed to examine AQP2 as a predictor of renal insufficiency and death in a large cohort of patients with cirrhosis. Furthermore, we looked for associations to disease severity and conventional markers of renal function. Methods: Urine samples from 199 patients (90 patients without organ failure at inclusion (Group 1), 58 patients with organ failure excluding renal failure at inclusion (Group 2) and 51 patients with organ failure including renal failure at inclusion (Group 3)) from the CANONIC study were collected and analyzed for urine osmolality and urine AQP2. Results: There were no differences in the concentration of AQP2 between the three groups. However, urine osmolality was significantly lower in patients in Group 3 compared to the two other groups. AQP2 did not correlate significantly with either GFR or creatinine and did not predict development of renal insufficiency. In a univariate analysis AQP2 showed statistical significance as a predictor of 14 and 28-day survival, but this did not hold true in a multivariate analysis. Conclusions: In our study, AQP2 was not related to either disease severity or markers of renal function. Neither did it show any potential as a predictor of development of renal insufficiency. However, we found a significant relation to death. In conclusion, AQP2 do not possess additional prognostic information as a novel marker of renal dysfunction.
SAT-044 SAFETY AND EFFICACY OF EARLY INITIATION OF BETA BLOCKERS IN CIRRHOTIC PATIENTS PRESENTING WITH ACUTE VARICEAL BLEEDING A. Salim1, U. Butt1, S. Afzal1, A. Butt1, K. Malik1, A. Alam1. 1 Gastroenterology, Shaikh Zayed Hospital, Lahore, Pakistan E-mail: [email protected]
SAT-043 AQUAPORIN-2 IN CIRRHOSIS: RELATION TO DISEASE SEVERITY, MARKERS OF RENAL FUNCTION AND IMPACT ON DEVELOPMENT OF RENAL INSUFFICIENCY AND MORTALITY T.M. Busk1,2, S. Møller1, E. Pedersen3, A. Gerbes4, A. Krag5, M. PeckRadosavljevic6, S. Frankova7, M.J. Coenraad8, F. Bendtsen2. 1Centre of Functional Imaging and Research, Department of Clinical Physiology and Nuclear Medicine; 2Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre; 3University Clinic of Nephrology and Hypertension, Aarhus University and Holstebro Hospital, Holstebro, Denmark; 4Liver Unit, Klinikum Munich, Ludwig Maximilian University of Munich, Munich, Germany; 5Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; 6 Department of Gastroenterology & Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt am Wörtersee, Klagenfurt, Austria;
Background and Aims: Esophageal variceal bleeding is a serious complication of liver cirrhosis. Primary treatment is with vasoactive agents and endoscopic therapy. Beta-blockers are used for secondary prophylaxis following initial endoscopic therapy. The Baveno consensus recommends starting beta-blockers from day 6 after initial endoscopy. The rationale for starting beta-blockers after day 5 is to reduce the risk of masking hemodynamic signs of rebleeding. Our aim was to see the safety and efficacy of early initiation of betablockers before day 6 following endoscopic therapy for secondary prophylaxis of variceal bleeding. Methods: Patients with liver cirrhosis presenting to our hospital with upper GI bleed were administered terlipressin 2 mg IV bolus followed by 1 mg 6 hourly until undergoing endoscopy. Patients with only esophageal varices as source of bleed were included in the study. Terlipressin was discontinued immediately following variceal band ligation. The patients were then observed for 12 hours after which they were discharged on oral carvedilol 6.25 mg BID. The patients were monitored for 6 weeks for rebleeding and mortality.
Journal of Hepatology 2016 vol. 64 | S631–S832
S669
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Department of Hepatogastroenterology, Institute for Clinical and Experimental, Prague, Czech Republic; 8Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands E-mail: [email protected] Background and Aims: In cirrhosis, renal failure is a serious complication with a high mortality in particular in patients who develop hepatorenal syndrome (HRS). Several methods for the assessment of renal function have been introduced within the last decades but in daily clinical practice, serum creatinine is the most frequently used measure for glomerular filtration rate (GFR). However, serum creatinine is an inaccurate marker of GFR in cirrhosis because of muscle wasting and increased renal excretion of creatinine in cirrhosis. There is therefore a need for alternative markers of renal function that are easy accessible. Aquaporin 2 (AQP2) is a measure of water channel transport in the principal cells in the distal part of the nephron and thought to be involved in water retention in cirrhosis. This has turned out be a promised biochemical marker of renal function. In this study, we aimed to examine AQP2 as a predictor of renal insufficiency and death in a large cohort of patients with cirrhosis. Furthermore, we looked for associations to disease severity and conventional markers of renal function. Methods: Urine samples from 199 patients (90 patients without organ failure at inclusion (Group 1), 58 patients with organ failure excluding renal failure at inclusion (Group 2) and 51 patients with organ failure including renal failure at inclusion (Group 3)) from the CANONIC study were collected and analyzed for urine osmolality and urine AQP2. Results: There were no differences in the concentration of AQP2 between the three groups. However, urine osmolality was significantly lower in patients in Group 3 compared to the two other groups. AQP2 did not correlate significantly with either GFR or creatinine and did not predict development of renal insufficiency. In a univariate analysis AQP2 showed statistical significance as a predictor of 14 and 28-day survival, but this did not hold true in a multivariate analysis. Conclusions: In our study, AQP2 was not related to either disease severity or markers of renal function. Neither did it show any potential as a predictor of development of renal insufficiency. However, we found a significant relation to death. In conclusion, AQP2 do not possess additional prognostic information as a novel marker of renal dysfunction.
SAT-044 SAFETY AND EFFICACY OF EARLY INITIATION OF BETA BLOCKERS IN CIRRHOTIC PATIENTS PRESENTING WITH ACUTE VARICEAL BLEEDING A. Salim1, U. Butt1, S. Afzal1, A. Butt1, K. Malik1, A. Alam1. 1 Gastroenterology, Shaikh Zayed Hospital, Lahore, Pakistan E-mail: [email protected]
SAT-043 AQUAPORIN-2 IN CIRRHOSIS: RELATION TO DISEASE SEVERITY, MARKERS OF RENAL FUNCTION AND IMPACT ON DEVELOPMENT OF RENAL INSUFFICIENCY AND MORTALITY T.M. Busk1,2, S. Møller1, E. Pedersen3, A. Gerbes4, A. Krag5, M. PeckRadosavljevic6, S. Frankova7, M.J. Coenraad8, F. Bendtsen2. 1Centre of Functional Imaging and Research, Department of Clinical Physiology and Nuclear Medicine; 2Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre; 3University Clinic of Nephrology and Hypertension, Aarhus University and Holstebro Hospital, Holstebro, Denmark; 4Liver Unit, Klinikum Munich, Ludwig Maximilian University of Munich, Munich, Germany; 5Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; 6 Department of Gastroenterology & Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt am Wörtersee, Klagenfurt, Austria;
Background and Aims: Esophageal variceal bleeding is a serious complication of liver cirrhosis. Primary treatment is with vasoactive agents and endoscopic therapy. Beta-blockers are used for secondary prophylaxis following initial endoscopic therapy. The Baveno consensus recommends starting beta-blockers from day 6 after initial endoscopy. The rationale for starting beta-blockers after day 5 is to reduce the risk of masking hemodynamic signs of rebleeding. Our aim was to see the safety and efficacy of early initiation of betablockers before day 6 following endoscopic therapy for secondary prophylaxis of variceal bleeding. Methods: Patients with liver cirrhosis presenting to our hospital with upper GI bleed were administered terlipressin 2 mg IV bolus followed by 1 mg 6 hourly until undergoing endoscopy. Patients with only esophageal varices as source of bleed were included in the study. Terlipressin was discontinued immediately following variceal band ligation. The patients were then observed for 12 hours after which they were discharged on oral carvedilol 6.25 mg BID. The patients were monitored for 6 weeks for rebleeding and mortality.
Journal of Hepatology 2016 vol. 64 | S631–S832
S669