Evaluation of malnutrition and renal function in hepatic cirrhosis; comparison of classic and new methods

In our study, we aimed to investigate the prevalence of malnutrition in patients with chronic liver disease, the effects of malnutrition on renal function and compare the reliability of several methods to assess renal function such as routine methods like creatinine and creatinine clearance against new generation methods in patients with chronic liver disease. Sixty six patients with chronic liver disease without any renal parenchymal or vascular disease and twenty two healthy controls were included in this study. Patients were divided into three groups according to Child-Pugh classification as Child A (n:22), Child B (n:22) and Child C (n:22). Patients' weights, body-mass indexes, body fat ratios, body muscle ratios, total body water ratios and visceral fat ratios were measured using a bioelectrical impedance scale. Albumin, prealbumin, transferrin, retinol binding protein and lymphocyte counts were used as nutritional laboratory measurements. All patients underwent Tc-99m DTPA renal scintigraphy to assess renal function to be used as reference. BUN, creatinine, cystatin C, beta trace protein (BTP), urinary NAG, urinary beta-2 microglobulin and creatinine clearance was compared with the reference method. Glomerular filtration rate calculations based on creatinine and cystatin C measurements were used for comparison as well. Patient and control groups were similar on nutritional clinical data, however, nutritional laboratory measurements were significantly lower in patients with chronic liver disease. Patients had significantly higher cystatin C and BTP levels, whereas creatinine clearance and Tc-99m DTPA based glomerular filtration rate was significantly lower than control group. There was a significant correlation between cystatin C and Tc-99m DTPA scans when the reference method and other renal parameters were compared. In estimated GFR formulas, cystatin C based CKD-EPI Cys and CKD-EPI Cys-Cr formulas were found the be most significantly correlated to Tc-99m DTPA scans. In conclusion, patients with liver failure may have renal insufficiency even if they have normal creatinine levels. In these patients, CKD EPI Cys-Cr and CKD EPI Cys formulas were found to be significantly consistent with the reference method. These formulas could be used as an important and accurate diagnostic method for renal insufficiency in patients with chronic liver failure. Key words: Cirrhosis, Malnutrition, Glomerular Filtration Rate, Cystatin C