Interest of the Echocardiography in the Management of Cirrhotic Patients With Acute Kidney Injury

Study Overview
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Brief Summary
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This prospective study focuses on the interest of the echocardiography for cirrhotic patients, who present acute kidney injury corresponding to the criteria of hepatorenal syndrome. This echocardiography will be done before the volemic expansion and the final diagnostic of hepatorenal syndrome or prerenal azotemia. The primary endpoint is to describe the hemodynamic characteristics of this population at the time of acute kidney injury and their association with diagnostic of hepatorenal syndrome or prerenal azotemia. Patients with elevated filling pressure, predicting poor outcome of volemic expansion will be excluded of the study after the echocardiography and will not undergo volemic expansion but appropriate management.

Official Title
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Interest of the Echocardiography in the Management of Cirrhotic Patients With Acute Kidney Injury

Conditions
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Cirrhosis, Hepatorenal Syndrome, Acute Kidney Injury, Diastolic Function

Intervention / Treatment
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* Procedure: Echocardiography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients > 18 years written consent for the participation of the study cirrhosis with portal hypertension and ascite acute kidney injury according to AKIN criteria (rapid increase of creatinine (48 hours) > 26.4 µmol or > 50% comparing with baseline). Baseline creatinine is the last value of creatinine before admission or creatinine at the admission if stable during 5 days. absence of argument for acute tubular necrosis or other organic acute renal injury absence of argument for shock Exclusion Criteria: pregnant women volemic expansion before echocardiography portal thrombosis presence of TIPSS history of cardiac or renal pathology atrial fibrillation cardiac valvulopathy technical limitation due to echogenicity

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: cirrhosis with portal hypertension,ascite and acute kidney<br> | Procedure: Echocardiography<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hemodynamic features assessed by echocardiography before the volemic expansion of cirrhotic patients with acute renal injury corresponding to the criteria of hepatorenal syndrome. | Systolic and diastolic function assessment, filling pressures, pulmonary arterial hypertension | At Day0 : at the time of diagnostic of acute kidney injury, before volemic expansion. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Tolerance of volemic expansion, as recommended by international guidelines | Clinical tolerance of volemic expansion, acute pulmonary oedema | After 48 hours of volemic expansion | 
| Response to vasoconstrictor treatment of hepatorenal syndrome, in case of diagnostic of hepatorenal syndrome | Renal function recovery, renal replacement therapy, liver transplantation | 1 month after inclusion | 
| Mortality |  | 1 month after inclusion | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cirrhosis, hepatorenal syndrome, acute kidney injury, diastolic function