Acute kidney injury after TIPS in decompensated cirrhosis patients: a retrospective cohort study

Acute kidney injury (AKI) is a common postoperative complication associated with increased mortality. The transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertension in patients with decompensated cirrhosis; however, the incidence and risk factors for AKI following TIPS in patients with cirrhosis have not been fully elucidated. We aimed to investigate the clinical features of AKI after TIPS in patients with cirrhosis. Data from 384 patients with decompensated cirrhosis who underwent TIPS treatment were retrospectively collected. AKI was defined using the criteria recommended by 2012 the clinical practice guideline of Kidney Disease Improving Global Outcomes (KDIGO). We conducted univariate and multivariate logistic regression analyses to evaluate the risk factors for AKI and the association between AKI and all-cause mortality. Of these 384 cirrhosis patients, 8.3% developed AKI after TIPS treatment. Multivariate logistic regression analysis indicated that independent risk factors associated with AKI were diabetes (OR = 3.632, 95% CI 1.358–9.711, P = 0.010), baseline estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m² (OR = 4.312, 95% CI 1.884–9.868, P = 0.001), serum albumin level (OR = 0.862, 95% CI 0.768–0.968, P = 0.012), postoperative portal venous pressure gradient (PPG) (OR = 1.094, 95% CI 1.010–1.185, P = 0.028), and intraoperative hypotension (OR = 4.669, 95% CI 1.653–13.183, P < 0.004); and AKI was independently associated with an increased risk of all-cause mortality within 3 months after TIPS treatment (OR 3.141, 95% CI 1.091–9.038, P = 0.034) . AKI in patients undergoing TIPS treatment is not uncommon; Diabetes, baseline kidney dysfunction, factors affecting effective circulatory volume, and higher postoperative PPG are closely associated with the occurrence of AKI. AKI is associated with an increased risk of all-cause mortality and medical expenses of those patients.