TY - JOUR
T1 - Renal function and cognitive impairment in patients with liver cirrhosis
AU - Kalaitzakis, Evangelos
AU - Björnsson, Einar
PY - 2007
Y1 - 2007
N2 - Objective. Cognitive impairment is a common problem in patients with liver cirrhosis. Its pathogenesis is multifactorial and ammonia is considered to play a central role. Renal function has been shown to be important for ammonia metabolism in cirrhosis. Although renal dysfunction is common in cirrhotic patients, its effect on cognitive function is largely unexplored. Material and methods. A total of 128 consecutive cirrhotic patients were prospectively evaluated for the presence of cognitive dysfunction according to the West-Haven criteria and by means of two psychometric tests. Serum creatinine, sodium and potassium as well as plasma ammonia concentrations were assessed. Glomerular filtration rate was also measured by 51Cr- EDTA clearance in a subgroup of patients. Results. Forty-one patients (32%) were found to have cognitive dysfunction (clinical evaluation and/or psychometric tests). Sixteen patients (13%) found with serum creatinine levels above reference values had cognitive dysfunction more frequently than patients with creatinine within the normal range (69% versus 31%; p=0.001), but did not differ in aetiology or severity of cirrhosis (p>0.1). Patients with loop diuretics versus without did not differ in creatinine values (p>0.1). Multivariate analysis showed that cognitive dysfunction was related to hospital admission at inclusion in the study, international normalized ratio and serum creatinine (p<0.05 for all), but not to potassium or sodium levels. Plasma ammonia concentration was related to serum creatinine (r=0.26, p=0.004) and the glomerular filtration rate (r=-0.44, p=0.023). Conclusions. Renal dysfunction seems to be related to cognitive impairment in patients with liver cirrhosis and might be implicated in the pathogenesis of hepatic encephalopathy.
AB - Objective. Cognitive impairment is a common problem in patients with liver cirrhosis. Its pathogenesis is multifactorial and ammonia is considered to play a central role. Renal function has been shown to be important for ammonia metabolism in cirrhosis. Although renal dysfunction is common in cirrhotic patients, its effect on cognitive function is largely unexplored. Material and methods. A total of 128 consecutive cirrhotic patients were prospectively evaluated for the presence of cognitive dysfunction according to the West-Haven criteria and by means of two psychometric tests. Serum creatinine, sodium and potassium as well as plasma ammonia concentrations were assessed. Glomerular filtration rate was also measured by 51Cr- EDTA clearance in a subgroup of patients. Results. Forty-one patients (32%) were found to have cognitive dysfunction (clinical evaluation and/or psychometric tests). Sixteen patients (13%) found with serum creatinine levels above reference values had cognitive dysfunction more frequently than patients with creatinine within the normal range (69% versus 31%; p=0.001), but did not differ in aetiology or severity of cirrhosis (p>0.1). Patients with loop diuretics versus without did not differ in creatinine values (p>0.1). Multivariate analysis showed that cognitive dysfunction was related to hospital admission at inclusion in the study, international normalized ratio and serum creatinine (p<0.05 for all), but not to potassium or sodium levels. Plasma ammonia concentration was related to serum creatinine (r=0.26, p=0.004) and the glomerular filtration rate (r=-0.44, p=0.023). Conclusions. Renal dysfunction seems to be related to cognitive impairment in patients with liver cirrhosis and might be implicated in the pathogenesis of hepatic encephalopathy.
KW - Ammonia
KW - Hepatic encephalopathy
KW - Liver cirrhosis
KW - Number connection test
KW - Renal function
UR - http://www.scopus.com/inward/record.url?scp=35148814117&partnerID=8YFLogxK
U2 - 10.1080/00365520701373983
DO - 10.1080/00365520701373983
M3 - Article
C2 - 17852846
AN - SCOPUS:35148814117
SN - 0036-5521
VL - 42
SP - 1238
EP - 1244
JO - Scandinavian Journal of Gastroenterology
JF - Scandinavian Journal of Gastroenterology
IS - 10
ER -