Interest of the Echocardiography in the Management of Cirrhotic Patients With Acute Kidney Injury

N/ACompletedNCT02097784

Hospices Civils de Lyon28 enrolled

Overview

This prospective study focuses on the interest of the echocardiography for cirrhotic patients, who present acute kidney injury corresponding to the criteria of hepatorenal syndrome. This echocardiography will be done before the volemic expansion and the final diagnostic of hepatorenal syndrome or prerenal azotemia. The primary endpoint is to describe the hemodynamic characteristics of this population at the time of acute kidney injury and their association with diagnostic of hepatorenal syndrome or prerenal azotemia. Patients with elevated filling pressure, predicting poor outcome of volemic expansion will be excluded of the study after the echocardiography and will not undergo volemic expansion but appropriate management.

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Conditions

Cirrhosis Hepatorenal Syndrome Acute Kidney Injury Diastolic Function

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * patients \> 18 years * written consent for the participation of the study * cirrhosis with portal hypertension and ascite * acute kidney injury according to AKIN criteria (rapid increase of creatinine (48 hours) \> 26.4 µmol or \> 50% comparing with baseline). Baseline creatinine is the last value of creatinine before admission or creatinine at the admission if stable during 5 days. * absence of argument for acute tubular necrosis or other organic acute renal injury * absence of argument for shock Exclusion Criteria: * pregnant women * volemic expansion before echocardiography * portal thrombosis * presence of TIPSS * history of cardiac or renal pathology * atrial fibrillation * cardiac valvulopathy * technical limitation due to echogenicity

Outcomes

Primary Outcomes

Hemodynamic features assessed by echocardiography before the volemic expansion of cirrhotic patients with acute renal injury corresponding to the criteria of hepatorenal syndrome.

Systolic and diastolic function assessment, filling pressures, pulmonary arterial hypertension

Time frame: At Day0 : at the time of diagnostic of acute kidney injury, before volemic expansion.

Secondary Outcomes

Tolerance of volemic expansion, as recommended by international guidelines

Clinical tolerance of volemic expansion, acute pulmonary oedema

Time frame: After 48 hours of volemic expansion

Response to vasoconstrictor treatment of hepatorenal syndrome, in case of diagnostic of hepatorenal syndrome

Renal function recovery, renal replacement therapy, liver transplantation

Time frame: 1 month after inclusion

Mortality