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Incidence and risk factors for acute renal failure in patients with hepatocellular carcinoma undergoing transarterial chemoembolization: a prospective study

Authors

  • Teh-Ia Huo,

    1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
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  • Jaw-Ching Wu,

    1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
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  • Pui-Ching Lee,

    1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
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  • Full-Young Chang,

    1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
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  • Shou-Dong Lee

    1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
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  • Financial support: This study was supported by a grant from Taipei Veterans General Hospital, Taipei, Taiwan.

Teh-Ia Huo, MD, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan.
Tel: +886 2 2871 2121 ext. 3352
Fax: +886 2 2873 9318/2876 1641
e-mail: tihuo@vghtpe.gov.tw

Abstract

Abstract: Background: Transarterial chemoembolization (TACE) is effective for hepatocellular carcinoma (HCC). Considerable amounts of radiocontrast agent are used for TACE and may induce renal dysfunction.

Method: This study prospectively investigated the incidence and risk factors of acute renal failure (ARF), defined as an increase of serum creatinine level >1.5 mg/dl after TACE.

Results: ARF developed in 12 (8.6%) of 140 patients after TACE. Univariate analysis showed that number of treatment sessions (2.3±1.4 vs 1.3±1.6, P=0.013), Child–Pugh class B (50% vs 21%, P=0.035) and the occurrence of severe postembolization syndrome (75% vs 30%, P=0.020) were significantly associated with the development of ARF. Multivariate logistic regression analysis disclosed that the proportional increased risk of ARF was 65% for each additional TACE therapy (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.13–2.41, P=0.010). Other independent risk factors were Child–Pugh class B (OR: 12.82, 95% CI: 2.44–67.29, P=0.003) and severe postembolization syndrome (OR: 6.64, 95% CI: 1.60–27.49, P=0.009). Four (33%) of the patients with ARF developed irreversible renal function impairment, and diabetes mellitus was the only associated factor (P=0.067) in this group.

Conclusions: ARF after TACE is closely associated with number of treatment sessions, severity of cirrhosis and development of severe postembolization syndrome. Effective preventive measures should be undertaken especially in high-risk patients.

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