Interaction between renal and liver impairment on the risk of lactic acidosis in diabetic patients with chronic hepatitis B-related cirrhosis
Refereed conference paper presented and published in conference proceedings


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AbstractBackground and Aim:
The risk of lactic acidosis across renal and liver function in cirrhotic patients with diabetes mellitus (DM) has not been well-documented. We examined the interaction between severity of renal and liver impairment on the risk of lactic acidosis in DM patients with chronic hepatitis B (CHB)-related cirrhosis.

Method:
A territory-wide cohort of DM patients with CHB-related cirrhosis from January 2000 to December 2017 was identified using the Clinical Data Analysis and Reporting System that captures in-patient and out-patient data of all public hospitals and clinics in Hong Kong. Lactic acidosis was defined by diagnosis codes, and/or blood pH ≤7.35 with lactate >5mmol/L or arterial bicarbonate ≤18mmol/L or venous bicarbonate ≤21mmol/L. Renal and liver function were modelled by time-dependent estimated glomerular filtration rate (eGFR) category and Child-Pugh class. Time-dependent use of medications and comorbidities were included in Fine-Gray model adjusted for competing risk of death. We excluded patients with eGFR <30 mL/min/1.73 m2 or renal replacement therapy at baseline.

Results:
4,627 DM patients with CHB-related cirrhosis were identified. Their mean age was 60.8±10.8 years, 3,360 (72.6%) were male; 1,652 (35.7%), 2,119 (45.8%), 574 (12.4%) and 282 (6.1%) had baseline eGFR ≥90, 60-89, 45-59 and 30-44 mL/min/1.73 m2. 3,440 (72.2%), 1,088 (23.5%) and 199 (4.3%) were in Child-Pugh class A, B and C at baseline. At a median (interquartile range) follow-up of 5.3 (2.0–9.6) years, 1,119 (24.2%) patients developed lactic acidosis. In Child-Pugh class A, the risk of lactic acidosis elevated in eGFR <45 mL/min/1.73 m2. The risk of lactic acidosis increased in Child-Pugh class B and C at any eGFR levels. The risk of lactic acidosis increased dramatically in Child-Pugh class C with eGFR <30 mL/min/1.73 m2 (Table).

Conclusion:
The risk of lactic acidosis increases with renal and liver impairment in DM patients with CHB-related cirrhosis. Child-Pugh class C with eGFR <30 mL/min/1.73 m2 is associated with a 102-fold increase in risk of lactic acidosis.
All Author(s) ListTerry Cheuk-Fung Yip, Vincent Wai-Sun Wong, Yee-Kit Tse, Henry Lik-Yuen Chan, Grace Lai-Hung Wong
Name of ConferenceEuropean Association for the Study of the Liver (EASL) The International Liver Congress™ 2019
Start Date of Conference10/04/2019
End Date of Conference14/04/2019
Place of ConferenceVienna
Country/Region of ConferenceAustria
Proceedings TitleJournal of Hepatology
Year2019
Month4
Volume Number70
Issue NumberSuppl 1
PublisherElsevier
Pagese696 - e696
ISSN0168-8278
eISSN1600-0641
LanguagesEnglish-United Kingdom

Last updated on 2020-23-05 at 02:09