Skip to main content

Advertisement

SpringerLink
Log in

Assessment of Liver Fibrosis by Transient Elastography Should Be Done After Hemodialysis in End Stage Renal Disease Patients with Liver Disease

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

The patients with end stage renal disease (ESRD) are at greater risk of acquiring chronic hepatitis B or C and subsequently development of liver disease. The aim of the study was to assess liver fibrosis by transient elastography (TE) and look for factors associated with change in liver stiffness measurement (LSM) with one session of hemodialysis (HD).

Methods

Consecutive ESRD patients on maintenance hemodialysis (MHD) with suspected liver disease were enrolled. They underwent LSM by TE before and after one session of HD. Bioelectric impedance analysis was done to evaluate the volume status at the time of TE.

Results

Sixty-eight patients with mean age of 40 ± 14 years were included. There was a significant reduction in LSM after HD (18.5 [95% CI 14.8–23.1] vs. 11.2 [95% CI 8.8–13.7] kPa, p < 0.001), with a mean LSM reduction of 7.2 [95% CI 5.25–9.19] kPa. On stratification in two groups by net ultrafiltration during HD (> or < 2.5 liters [L]), change in LSM was substantially higher in patients when total fluid removed was > 2.5 L (8.6 [95% CI 5.7–11.5] vs. 5.1 [95% CI 2.9–7.5], p = 0.05). In 18 patients who underwent liver biopsy, LSM after HD performed better at detecting significant fibrosis, with area under receiver operating characteristics curve 0.71 [95% CI 0.46–0.97], versus 0.64 [95% CI 0.38–0.90], respectively. An LSM value of 12.2 kPa after HD was 71% sensitive and 74% specific for detection of significant fibrosis (≥ F2), while values less than 9 kPa ruled out significant fibrosis with a sensitivity and specificity of 37 and 100%, respectively.

Conclusion

LSM by TE decreases significantly after HD in patients with ESRD on long-term MHD. Hence, TE should be done after HD for accurate assessment of liver fibrosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Chacko EC, Surrun SK, Mubarack Sani TP, Pappachan JM. Chronic viral hepatitis and chronic kidney disease. Postgrad Med J. 2010;86:486–492.

    Article  PubMed  Google Scholar 

  2. Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD, American Association for the Study of Liver Diseases. Liver biopsy. Hepatology. 2009;49:1017–1044.

    Article  PubMed  Google Scholar 

  3. Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol. 2008;48:835–847.

    Article  PubMed  Google Scholar 

  4. Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new non-invasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29:1705–1713.

    Article  PubMed  Google Scholar 

  5. Nguyen-Khac E, Capron D. Noninvasive diagnosis of liver fibrosis by ultrasonic transient elastography (Fibroscan). Eur J Gastroenterol Hepatol. 2006;18:1321–1325.

    Article  PubMed  Google Scholar 

  6. Roulot D, Czernichow S, Le Clesiau H, Costes JL, Vergnaud AC, Beaugrand M. Liver stiffness values in apparently healthy subjects: influence of gender and metabolic syndrome. J Hepatol. 2008;48:606–613.

    Article  PubMed  Google Scholar 

  7. Castera L, Pinzani M. Non-invasive assessment of liver fibrosis: are we ready? Lancet. 2010;375:1419–1420.

    Article  PubMed  Google Scholar 

  8. Talwalkar JA, Kurtz DM, Schoenleber SJ, West CP, Montori VM. Ultrasound-based transient elastography for the detection of hepatic fibrosis: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2007;5:1214–1220.

    Article  PubMed  Google Scholar 

  9. Castera L, Pinzani M. Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango? Gut. 2010;59:861–866.

    Article  PubMed  Google Scholar 

  10. Millonig G, Reimann FM, Friedrich S, et al. Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology. 2008;48:1718–1723.

    Article  PubMed  Google Scholar 

  11. Coco B, Oliveri F, Maina AM, et al. Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases. J Viral Hepat. 2007;14:360–369.

    Article  CAS  PubMed  Google Scholar 

  12. Arena U, Vizzutti F, Corti G, et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology. 2008;47:380–384.

    Article  CAS  PubMed  Google Scholar 

  13. Trabut JB, Thepot V, Nalpas B, et al. Rapid decline of liver stiffness following alcohol withdrawal in heavy drinkers. Alcohol Clin Exp Res. 2012;36:1407–1411.

    Article  CAS  PubMed  Google Scholar 

  14. Millonig G, Friedrich S, Adolf S, et al. Liver stiffness is directly influenced by central venous pressure. J Hepatol. 2010;52:206–210.

    Article  PubMed  Google Scholar 

  15. Koch A, Horn A, Duckers H, et al. Increased liver stiffness denotes hepatic dysfunction and mortality risk in critically ill non-cirrhotic patients at a medical ICU. Crit Care. 2011;15:R266.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Liu CH, Liang CC, Huang KW, et al. Transient elastography to assess hepatic fibrosis in hemodialysis chronic hepatitis C patients. Clin J Am Soc Nephrol. 2011;6:1057–1065.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Castera L, Vergniol J, Foucher J, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128:343–350.

    Article  PubMed  Google Scholar 

  18. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Composition of the ESPEN working group. Bioelectrical impedance analysis–part I: review of principles and methods. Clin Nutr. 2004;23:1226–1243.

    Article  PubMed  Google Scholar 

  19. Del Poggio P, Colombo S. Is transient elastography a useful tool for screening liver disease? World J Gastroenterol. 2009;15:1409–1414.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ziol M, Handra-Luca A, Kettaneh A, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology. 2005;41:48–54.

    Article  PubMed  Google Scholar 

  21. Giallourakis CC, Rosenberg PM, Friedman LS. The liver in heart failure. Clin Liver Dis. 2002;6:947–967.

    Article  PubMed  Google Scholar 

  22. Colli A, Pozzoni P, Berzuini A, et al. Decompensated chronic heart failure: increased liver stiffness measured by means of transient elastography. Radiology. 2010;257:872–878.

    Article  PubMed  Google Scholar 

  23. Kellner P, Anadol E, Huneburg R, et al. The effect of hemodialysis on liver stiffness measurement: a single-center series. Gastroenterol Hepatol. 2013;25:368–372.

    Google Scholar 

  24. Khunpakdee N, Jayanama K, Kaewdoung P, et al. Transient elastography in end-stage renal disease patients on hemodialysis: the effect of net fluid withdrawal. Blood Purif. 2015;40:256–259.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Sunil Taneja, Amritangsu Borkakoty, Sahaj Rathi, Ajay Duseja, Radha K. Dhiman & Yogesh Chawla

  2. Departments of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Vivek Kumar & Krishan L. Gupta

Authors
  1. Sunil Taneja
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amritangsu Borkakoty
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sahaj Rathi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vivek Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ajay Duseja
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Radha K. Dhiman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Krishan L. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yogesh Chawla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sunil Taneja.

Ethics declarations

Conflict of interest

The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taneja, S., Borkakoty, A., Rathi, S. et al. Assessment of Liver Fibrosis by Transient Elastography Should Be Done After Hemodialysis in End Stage Renal Disease Patients with Liver Disease. Dig Dis Sci 62, 3186–3192 (2017). https://doi.org/10.1007/s10620-017-4777-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-017-4777-6

Keywords

Search

Navigation