The prevalence and association of chronic kidney disease and diabetes in liver cirrhosis using different estimated glomerular filtration rate equation

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// Cheng-Yi Chen 1, 2, 3 , Cheng-Jui Lin 2, 4, 5 , Chih-Sheng Lin 3 , Fang-Ju Sun 2, 6 , Chi-Feng Pan 2, 4 , Han-Hsiang Chen 2, 4 and Chih-Jen Wu 4, 5, 7, 8 1 Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Hsinchu, Taiwan 2 MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan 3 Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan 4 Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan 5 Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 6 Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan 7 Graduate Institute of Medical Sciences and Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 8 Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan Correspondence to: Chih-Jen Wu, email: wcjyali@yahoo.com.tw Keywords: liver cirrhosis; chronic kidney disease; diabetes mellitus; estimated glomerular filtration rate; MELD score Received: June 02, 2017 Accepted: August 29, 2017 Published: December 18, 2017 ABSTRACT Background: Chronic kidney disease (CKD) in cirrhosis is one of the dreaded complications associated with a steep rise in mortality and morbidity, including diabetes. There are limited data on the prevalence of CKD and the association with diabetes in outpatients with cirrhosis. Methodology: This is a cross-sectional study of 7,440 adult liver cirrhosis patients enrolled from August 2001 to April 2010 in a medical center. Case control matching by age and sex with 1,967 pairs, and conditional logistic regression for odds of diabetes was analyzed using adjusted model. Results: CKD was present in 46.0%, 45.7% and 45.6% of the study population using the MDRD-6, CKD-EPI and MDRD-4 estimated glomerular filtration rate (eGFR) equations, respectively. Using a conditional logistic regression model after adjusting for other risk factors, odds for diabetes increased significantly compared with non-CKD in CKD stage 3 to 5 (stage 3~5) based on MDRD-6–adjusted model, ORs were: stage 3~5, 2.34 (95% CI, 1.78-3.01); MDRD-4–adjusted model, ORs were: stage 3~5, 8.51 (95% CI, 5.63-11.4); CKD-EPI–adjusted model, ORs were: stage 3~5, 8.61 (95% CI, 5.13-13.9). Conclusion: In cirrhosis patients, prevalence of diabetes was higher in patients with advanced stage of CKD. For patients with cirrhosis, patients with CKD stages 3~5 defined by MDRD-4, MDRD-6, and CKD-EPI eGFR equations had increased risk for diabetes. More severe cirrhosis, indicated by the Child-Turcott-Pugh classification was also accompanied by an increased risk for diabetes.

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