Research

The Clínic-IDIBAPS participates in the international guidelines for the management of ascites, kidney infections and the renal complications of liver cirrhosis

Professionals from the Hospital Clínic-IDIBAPS and CIBEREHD participated in the preparation of the international guidelines produced by the American Association for the Study of Liver Diseases (AASLD) for the management of ascites, kidney infections and renal complications in patients with liver cirrhosis.  Ascites is one of the main complications of cirrhosis and consists of the abnormal accumulation of fluid in the abdomen.  Moreover, these patients often develop kidney infections and impaired renal function.

Dr. Pere Ginés, author of the guidelines (Picture: Francisco Avia).

A small group of experts in this field participated in the guidelines that were published in the journal Hepatology. These experts include Dr. Pere Ginés, head of the Hospital Clínic Hepatology Service and of the IDIPABS Chronic liver diseases: molecular mechanisms and clinical consequences research group, and also a researcher at CIBEREHD.

One of the most frequent complications of cirrhosis

Ascites is one of the most frequent complications of liver cirrhosis, and its appearance is associated with a poor prognosis, with a 30% survival rate at five years. This poor prognosis is partly because patients with ascites tend to have additional complications such as bacterial infections, nutritional imbalances or hepatorenal syndrome.

Hepatorenal syndrome, in turn, is a very serious complication that can occur in patients with cirrhosis or other chronic kidney diseases and ascites.  This is a functional acute kidney injury (that does not affect the renal tissue) and is potentially reversible. It occurs in 10% of patients with advanced cirrhosis.

Guide based on clinical research data

The new guidelines published in the journal Hepatology update the information currently available on the diagnosis, evaluation and management of ascites, kidney infections and impaired renal function, in particular hepatorenal syndrome, in patients with liver cirrhosis.  An international panel of experts participated in this guidance and provided advice and guidelines based on an exhaustive review and analysis of the literature on this subject.

"A great deal of the recommendations included in this guidance are based on clinical research, in particular Randomized Controlled Trials, carried out by our research group at the Hospital Clínico-IDIBAPS", explains Dr. Pere Ginés.

The guidelines describe the pathogenesis of this complication, the key points to bear in mind for its diagnosis, the management of the patient with ascites, irrespective of its cause, and places particular emphasis on ascites in cirrhosis patients.  It also devotes a section to cases of ascites that do not respond to treatment and that lower the patients’ survival rate to 50% at 6 months post-diagnosis. The guidelines carry out an in-depth examination of the different treatments that are currently available and provides recommendations on each of them.

Moreover, it also focuses on the hepatorenal syndrome, a type of acute kidney injury that is common in patients with decompensated cirrhosis and ascites, and looks at the diagnosis and treatment of this complication, as well as its prevention in order to reduce the associated mortality.

Reference to the guidelines:

Diagnosis, evaluation, and management of ascites and hepatorenal syndrome.
Biggins SW, Angeli P, Garcia-Tsao G, Ginès P, Ling S, Nadim MK, Wong F, Kim WR.
Hepatology. 2021 May 3. doi: 10.1002/hep.31884.