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Cirrhosis negatively affects 2-year survival in haemodialysis patients

15 Jun 2019

Cirrhosis is associated with mortality among haemodialysis patients, and those with severe disease have poorer 2-year outcomes, according to a recent study.

Researchers looked at 7,658 patients with end‐stage renal failure who were undergoing haemodialysis, among whom 304 (4 percent) had cirrhosis. They recorded clinical data, cirrhosis status and its severity at haemodialysis initiation.

The primary endpoint of 2‐year survival was more favourable in noncirrhotic than in cirrhotic patients (71.7 percent vs 54.4 percent; p<0.0001). Moreover, those with decompensated cirrhosis had a worse 2‐year outcome (44.1 percent) relative to patients with compensated cirrhosis (62.8 percent; p=0.002) or noncirrhotic patients (71.7 percent; p<0.0001).

Compensated and decompensated cirrhosis emerged as independent predictors of 2‐year mortality.

In sensitivity analysis restricted to cirrhotic patients, 2‐year survival was higher in Child‐Pugh A patients than in those with Child‐Pugh B and C (65.5 percent vs 27.7 percent vs 0 percent; p<0.0001).

Predictive models integrating MELD or Child‐Pugh scores and extrahepatic comorbidities allowed correct prediction of 2-year survival in about 70 percent of patients. The area under the receiver-operating characteristic (AUROC) curves were 0.73 with 69.8 percent correctly classified patients for model 1 (based on ascites and MELD score) and 0.75 with 70.4 percent correctly classified patients for model 2 (based on ascites and Child-Pugh score).

The findings suggest that cirrhosis exerts a deleterious impact on 2‐year survival in haemodialysis patients, the researchers said. Furthermore, predictive models integrating severity of cirrhosis and comorbidities show promise in providing rational evidences to guide therapeutic management in cirrhotic haemodialysis patients.

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