• Mendelian randomization
• metabolic dysfunction‐associated steatotic liver disease
• renal function
• sleep

• Humans
• Male
• Female
• Middle Aged
• Sleep Wake Disorders/epidemiology
• Sleep Wake Disorders/complications
• Sleep Wake Disorders/physiopathology
• Fatty Liver/epidemiology
• Fatty Liver/complications
• Fatty Liver/physiopathology
• Risk Factors
• Adult
• Incidence
• Cohort Studies
• Mendelian Randomization Analysis
• Renal Insufficiency, Chronic/epidemiology
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/etiology
• Renal Insufficiency, Chronic/physiopathology
• Severity of Illness Index
• Metabolic Diseases/epidemiology
• Metabolic Diseases/complications
• Aged
• Proportional Hazards Models

• YG2021QN54 Star Program of Shanghai Jiaotong University
• TC2022B016 The Open Project of Jiangsu Provincial Science and Technology Resources (Clinical Resources) Coordination Service Platform
• 2021zhyx-B04 Research Fund of Anhui Institute of Translational Medicine
• BK20230129 The Jiangsu Provincial Natural Science Funds for Young Scholar
• 20190104 SJTU Trans-med Awards Research
• 82100605 National Natural Science Foundation of China
• 82103932 National Natural Science Foundation of China
• 82304236 National Natural Science Foundation of China

• liver cirrhosis

• Humans
• Prognosis
• Prospective Studies
• Liver Cirrhosis/complications
• End Stage Liver Disease
• Interleukin-6
• Severity of Illness Index
• Biomarkers

• Cirrhosis
• Hepatitis B virus
• Hepatorenal syndrome
• Model
• Predictors
• Retrospective study

• Acute kidney failures
• Acute kidney injuries
• Acute-on-chronic liver failure (ACLF)
• Acute-on-chronic liver failures
• Chronic liver failure
• Cirrhosis
• Creatinine
• Cystatin C
• End-stage liver disease
• Hepatic cirrhosis
• Hepatorenal syndrome
• Liver

• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/etiology
• Acute-On-Chronic Liver Failure/diagnosis
• Acute-On-Chronic Liver Failure/etiology
• Adult
• Biomarkers
• Creatinine
• Cystatin C/blood
• End Stage Liver Disease
• Female
• Humans
• Male
• Middle Aged
• ROC Curve
• Severity of Illness Index

• biomarker
• chronic liver disease
• complication
• liver cirrhosis
• mortality

• Acute Kidney Injury/diagnostic imaging
• Acute Kidney Injury/etiology
• Ascites/diagnostic imaging
• Ascites/etiology
• Biomarkers
• Creatinine
• Elasticity Imaging Techniques
• Hepatorenal Syndrome/diagnostic imaging
• Humans
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnostic imaging

Liver cirrhosis is the terminal stage of most chronic liver conditions, with a high risk of mortality. Careful evaluation of the prognosis of cirrhotic patients and providing precise management are crucial to reduce the risk of mortality. Although the liver biopsy and hepatic venous pressure gradient (HVPG) can efficiently evaluate the prognosis of cirrhotic patients, their application is limited due to the invasion procedures. Child-Pugh score and the model for end-stage liver disease (MELD) score had been widely used in the assessment of cirrhotic prognosis, but the defects of subjective variable application in Child-Pugh score and unsuitability to all phases of liver cirrhosis in MELD score limit their prognostic values. In recent years, continuous efforts have been made to investigate the prognostic value of body fluid biomarkers for cirrhotic patients, and promising results have been reported. Since the collection of fluid specimens is easy, noninvasive, and repeatable, fluid biomarkers can be ideal indicators to predict the prognosis of cirrhosis. Here, we reviewed noninvasive fluid biomarkers in different prognostic functions, including the prediction of survival and complication development.

• Terlipressin
• acute kidney injury (AKI)
• bleeding
• cirrhosis
• cystatin C (CysC)

• acute kidney injury
• biomarkers
• cirrhosis
• cystatin C
• neutrophil gelatinase-associated lipocalin

Some studies have reported that renal dysfunction is associated with poor prognosis in cirrhotic patients. Serum cystatin C (CysC) is an accurate biomarker for early renal dysfunction. This study aimed to assess the prognostic value of serum CysC levels in patients with hepatitis B virus-related decompensated cirrhosis (HBV-DeCi).

This retrospective study included 75 subjects who had been diagnosed with HBV-DeCi. The association between serum CysC and prognosis was estimated by receiver operating characteristic curve analysis and a multivariable logistic regression model.

Serum CysC levels were higher in nonsurvivors than in survivors and were positively correlated with model for end-stage liver disease (MELD) scores. In multivariate analysis, CysC and the MELD score were independent prognostic factors in all HBV-DeCi patients. However, only serum CysC was an independent factor predicting mortality in patients with normal creatinine levels.

These data suggest that high serum CysC levels can be considered an independent biomarker of 3-month mortality in patients with HBV-DeCi.

• creatinine
• cystatin C
• hepatorenal syndrome
• liver cirrhosis
• renal dysfunction

Hepatorenal syndrome (HRS) plays an important role in patients with liver cirrhosis on the wait list for liver transplantation (LT). The 1 and 5-year probability of developing HRS in cirrhotic with ascites is 20% and 40%, respectively. In this article, we reviewed current concepts in HRS pathophysiology, guidelines for HRS diagnosis, effective treatment options presently available, and controversies surrounding liver alone vs simultaneous liver kidney transplant (SLKT) in transplant candidates. Many treatment options including albumin, vasoconstrictors, renal replacement therapy, and eventual LT have remained a mainstay in the treatment of HRS. Unfortunately, even after aggressive measures such as terlipressin use, the rate of recovery is less than 50% of patients. Moreover, current SLKT guidelines include: (1) estimation of glomerular filtration rate of 30 mL/min or less for 4-8 wk; (2) proteinuria > 2 g/d; or (3) biopsy proven interstitial fibrosis or glomerulosclerosis. Even with these updated criteria there is a lack of consistency regarding long-term benefits for SLKT vs LT alone. Finally, in regards to kidney dysfunction in the post-transplant setting, an estimation of glomerular filtration rate < 60 mL/min per 1.73 m² may be associated with an increased risk of patients having long-term end stage renal disease. HRS is common in patients with cirrhosis and those on liver transplant waitlist. Prompt identification and therapy initiation in transplant candidates with HRS may improve post-transplantation outcomes. Future studies identifying optimal vasoconstrictor regimens, alternative therapies, and factors predictive of response to therapy are needed. The appropriate use of SLKT in patients with HRS remains controversial and requires further evidence by the transplant community.

• Liver transplantation
• Simultaneous liver kidney transplantation
• Vasopressors
• Dialysis
• Post-transplant outcomes
• Hepatorenal syndrome

• creatinine
• cystatin C
• glomerular filtration rate
• outcome

• alcohol
• hepatorenal syndrome
• liver cirrhosis
• predictors

• Acute Kidney Injury/etiology
• Albumins/therapeutic use
• Analysis of Variance
• Antihypertensive Agents/therapeutic use
• Female
• Follow-Up Studies
• Hepatorenal Syndrome/diagnosis
• Hepatorenal Syndrome/drug therapy
• Hepatorenal Syndrome/etiology
• Humans
• Liver Cirrhosis, Alcoholic/complications
• Lypressin/analogs & derivatives
• Lypressin/therapeutic use
• Male
• Middle Aged
• Risk Factors
• Terlipressin

Acute kidney injury (AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome (HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice.

• Hepatorenal syndrome
• Cirrhosis
• Acute kidney injury
• Diagnosis
• Treatment
• Terlipressin
• Liver support system

• Acute kidney injury
• Cirrhosis
• Liver transplantation
• SLK

Chronic kidney disease (CKD) typically evolves over many years, with a long latent period when the disease is clinically silent and therefore diagnosis, evaluation and treatment is based mainly on biomarkers that assess kidney function. Glomerular filtration rate (GFR) remains the ideal marker of kidney function. Unfortunately measuring GFR is time consuming and therefore GFR is usually estimated from equations that take into account endogenous filtration markers like serum creatinine (SCr) and cystatin C (CysC). Other biomarkers such as albuminuria may precede kidney function decline and have demonstrated to have strong associations with disease progression and outcomes. New potential biomarkers have arisen with the promise of detecting kidney damage prior to the currently used markers. The aim of this review is to discuss the utility of the GFR estimating equations and biomarkers in CKD and the different clinical settings where these should be applied. The CKD-Epidemiology Collaboration equation performs better than the modification of diet in renal disease equation, especially at GFR above 60 mL/min per 1.73 m². Equations combining CysC and SCr perform better than the equations using either CysC or SCr alone and are recommended in situations where CKD needs to be confirmed. Combining creatinine, CysC and urine albumin to creatinine ratio improves risk stratification for kidney disease progression and mortality. Kidney injury molecule and neutrophil gelatinase-associated lipocalin are considered reasonable biomarkers in urine and plasma to determine severity and prognosis of CKD.

• Chronic kidney disease
• Estimated glomerular filtration rate
• Kidney damage
• New biomarkers
• MicroRNA

HBV-related acute-on-chronic liver failure (HBV-ACLF) is a severe liver disease which results in a high mortality in China. To early predict the prognosis of the patients may prevent the complications and improve the survival. This study was aimed to develop a new prognostic index to estimate the survival related to HBV-ACLF.

Consecutive patients with HBV-ACLF were included in a prospective observational study. Serum Cystatin C concentrations were measured by using the particle-enhanced immunonephelometry assay. All of the patients were followed for at least 3 months. Cox regression analysis was carried out to identify which factors were predictive of mortality. The area under the receiver operating characteristic curve (AUC) was used to evaluate the efficacy of the variates for early predicting mortality.

Seventy-two patients with HBV-ACLF were recruited between January 2012 and January 2013. Thirty patients died (41.7%) during 3-months followed up. Cox multivariate regression analysis identified serum cystatin C (CysC) and total bilirubin (TBil) were independent factors significantly (P < 0.01) associated with survival. Our results further showed that new prognostic index (PI) combining serum CysC with TBil was a good indicator for predicting the mortality of patients with HBV-ACLF. Specifically, the PI had a higher accuracy than the CTP, MELD, or MELD-Na scoring for early prediction short-term survival of HBV-ACLF patients with normal levels of serum creatinine (Cr). The survival rate in low risk group (PI < 3.91) was 94.3%, which was markedly higher than those in the high-risk group (PI ≥ 3.91) (17.4%, P < 0.001).

We developed a new prognostic index combining serum CysC with TBil which early predicted the short-term mortality of HBV-ACLF patients.

AIM: To investigate serum cystatin C level as an early biomarker for predicting acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF).

METHODS: Fifty-six consecutive patients with hepatitis B virus-related ACLF who had normal serum creatinine (Cr) level (< 1.2 mg/dL in men, or < 1.1 mg/dL in women) were enrolled in the Liver Failure Treatment and Research Center of Beijing 302 Hospital between August 2011 and October 2012. Thirty patients with chronic hepatitis B (CHB) and 30 healthy controls in the same study period were also included. Measurement of serum cystatin C (CysC) was performed by a particle-enhanced immunonephelometry assay using the BN Prospec nephelometer system. The ACLF patients were followed during their hospitalization period.

RESULTS: In the ACLF group, serum level of CysC was 1.1 ± 0.4 mg/L, which was significantly higher (P < 0.01) than those in the healthy controls (0.6 ± 0.3 mg/L) and CHB patients (0.7 ± 0.2 mg/L). During the hospitalization period, eight ACLF patients developed AKI. Logistic regression analysis indicated that CysC level was an independent risk factor for AKI development (odds ratio = 1.8; 95%CI: 1.4-2.3, P = 0.021). The cutoff value of serum CysC for prediction of AKI in ACLF patients was 1.21 mg/L. The baseline CysC-based estimated glomerular filtration rate (eGFR_CysC) was significantly lower than the creatinine-based eGFR (eGFR_CG and eGFR_MDRD) in ACLF patients with AKI, suggesting that baseline eGFR_CysC represented early renal function in ACLF patients while the Cr levels were still within the normal ranges.

CONCLUSION: Serum CysC provides early prediction of renal dysfunction in ACLF patients with a normal serum Cr level.

• Acute-on-chronic liver failure
• Cystatin C
• Creatinine
• Acute kidney injury
• Prediction

• Acute Kidney Injury/blood
• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/etiology
• Adult
• Biomarkers/blood
• Case-Control Studies
• Creatinine/blood
• Cystatin C/blood
• Early Diagnosis
• End Stage Liver Disease/blood
• End Stage Liver Disease/diagnosis
• End Stage Liver Disease/etiology
• Female
• Hepatitis B, Chronic/complications
• Humans
• Liver Failure, Acute/blood
• Liver Failure, Acute/diagnosis
• Liver Failure, Acute/etiology
• Logistic Models
• Male
• Middle Aged
• Models, Biological
• Nephelometry and Turbidimetry
• Odds Ratio
• Predictive Value of Tests
• Risk Factors
• Time Factors
• Up-Regulation

• Cystatin C
• chronic kidney disease
• glomerular filtration rate (GFR) estimation