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Renal function evaluation in liver cirrhosis: Preliminary report on the effect of the Royal Free Hospital Cirrhosis Glomerular Filtration Rate on the Model for End-Stage Liver Disease (MELD)

Published:December 16, 2017DOI:https://doi.org/10.1016/j.ejim.2017.12.003
      Serum creatinine and estimated glomerular filtration rate (eGFR), determined using the Modification of Diet Renal Disease (MDRD)-4, the MDRD-6 or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, substantially overestimate kidney function in patients with liver cirrhosis [
      • Cholongitas E.
      • Shusang V.
      • Marelli L.
      • Nair D.
      • Thomas M.
      • Patch D.
      • et al.
      Review article: renal function assessment in cirrhosis—difficulties and alternative measurements.
      ]. By directly measuring GFR, Kalafateli et al. developed an alternative eGFR formula, the Royal Free Hospital (RFH) cirrhosis GFR, that more accurately estimates GFR in cirrhotic patients [
      • Kalafateli M.
      • Wickham F.
      • Burniston M.
      • Cholongitas E.
      • Theocharidou E.
      • Garcovich M.
      • et al.
      Development and validation of a mathematical equation to estimate glomerular filtration rate in cirrhosis: the royal free hospital cirrhosis glomerular filtration rate.
      ]. The tight correlation between measured GFR and RFH cirrhosis GFR was later confirmed by Pedersen et al. [
      • Pedersen J.S.
      • Kimer N.
      • Henriksen J.H.
      • Bendtsen F.
      • Møller S.
      The royal free hospital cirrhosis glomerular filtration rate: validation in a Danish cohort.
      ] By reversely applying commonly used eGFR formulae to measured GFR, Kalafateli et al. derived “corrected creatinine” values that were used to calculate “corrected Model for End-Stage Liver Disease (MELD)” scores [
      • Kalafateli M.
      • Wickham F.
      • Burniston M.
      • Cholongitas E.
      • Theocharidou E.
      • Garcovich M.
      • et al.
      Development and validation of a mathematical equation to estimate glomerular filtration rate in cirrhosis: the royal free hospital cirrhosis glomerular filtration rate.
      ]. Median “corrected MELD” was 3 points higher than conventional MELD, and this could impact patient allocation for liver transplantation. However, superiority of “corrected” over conventional MELD as prognostic index in cirrhosis has yet to be demonstrated.
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