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Wide renal vein dilation linked to worse survival in cirrhotic ascites

New data has shown an association between renal vein diameter of 11 mm or wider and shorter median overall survival among patients with refractory cirrhotic ascites.

“The results of the present study suggest that renal vein dilation determined using noncontrast CT is an independent predictor of mortality in the setting of massive cirrhotic ascites, regardless of the MELD-Na score,” Naoki Matsumoto, MD, from the Nihon University School of Medicine, Japan, and colleagues wrote. “The mechanism of renal venous hypertension is considered as [inferior vena cava] compression by the liver and ascetic fluid.”

Two hepatology researchers measured the left renal vein diameter of 142 patients with cirrhotic ascites admitted to their center between December 2008 and July 2016. “The left renal vein was measured ... because multiple renal veins were more frequently observed in the right side than the left side,” the researchers wrote. “The major and minor axes of the [inferior vena cava] were measured downstream of the bilateral renal veins.”

Causes of cirrhosis were hepatitis C (n = 45), alcohol consumption (n = 51), hepatitis B (n = 8), HCV with alcohol consumption (n = 9) and others (n = 29). Patients underwent paracentesis to exclude other causes of ascites.

The 26 patients with a left renal vein diameter of 11 mm or wider had a median OS of 2.5 months and 1-year survival rate of 15.3% vs. a median OS of 32 months and 1-year survival rate of 66.4% among the patients with a small renal vein diameter.

After further division by diameter, median OS was 32 months for those with a renal vein diameter below 7.5 mm, 19.5 months for the 7.5 mm to 12.5 mm group and 1.9 months for the 12.5 mm or wider group.

Compared with patients with smaller renal vein diameters, those with a diameter of 11 mm or wider were on average younger (62 vs. 69 years; P = .013), had a higher MELD score (13 vs. 11; P = .002) and MELD-Na score (17 vs. 13; P = .001), were more likely to have Child-Pugh class C (P = .014), had higher total bilirubin levels (4.1 vs. 1.5 mg/dL; P < .001) and direct bilirubin levels (2.8 vs. 0.8 mg/dL; P < .001), and had a higher international normalized ratio (1.52 vs. 1.21; P < .001).

On multivariate analysis, independent predictors of mortality included higher MELD-Na score (HR = 3.388; 95% CI, 2.001-5.737) and renal vein diameter of 11 mm or wider (HR = 2.944; 95% CI, 1.666-5.203).

“In the setting of decompensated liver cirrhosis, renal venous hypertension may arise from [inferior vena cava] compression by the liver and from abdominal ascites. We consider that the renal vein diameter is likely correlated with renal venous pressure because the [inferior vena cava] diameter has been positively correlated with [central venous pressure] in previous studies,” the researchers concluded. “We consider renal vein dilation as an equivalent of renal venous hypertension. The results of the present study demonstrate that renal venous hypertension is associated with poorer outcomes in patients with cirrhotic ascites.” – by Talitha Bennett

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