China: A retrospective cohort study published in BMC Nephrology has highlighted that acute kidney injury (AKI) is a relatively frequent and clinically significant complication following transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with decompensated cirrhosis.
The study, conducted by Meng Jia from the Department of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China, and colleagues, identified several metabolic, renal, and hemodynamic factors that increase the likelihood of AKI and demonstrated its association with higher short-term mortality and healthcare costs.
TIPS is widely used to manage portal hypertension-related complications such as refractory ascites and variceal bleeding in patients with advanced cirrhosis. Despite its benefits, concerns remain regarding postoperative complications, particularly renal dysfunction, which can adversely affect outcomes. While AKI is known to worsen prognosis in cirrhosis, data specifically addressing its occurrence after TIPS have been limited.
To address this gap, the researchers retrospectively analyzed data from 384 patients with decompensated cirrhosis who underwent TIPS. Acute kidney injury was defined according to the 2012 Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines. Using both univariate and multivariate logistic regression models, the investigators assessed potential predictors of AKI and examined its relationship with all-cause mortality within three months following the procedure.
The analysis revealed the following findings:
- AKI occurred in 8.3% of patients following TIPS placement.
- Diabetes was a significant independent predictor, with affected patients having more than a threefold higher risk of developing AKI.
- Pre-existing kidney dysfunction markedly increased risk, as patients with a baseline eGFR below 60 ml/min/1.73 m² showed over a fourfold rise in AKI incidence.
- Lower serum albumin levels were associated with a greater likelihood of AKI, indicating the role of poor nutritional status and reduced effective circulatory volume.
- A higher postoperative portal venous pressure gradient independently increased the risk of AKI, suggesting inadequate portal decompression may impair renal perfusion.
- Intraoperative hypotension was strongly linked to AKI, highlighting the importance of maintaining hemodynamic stability during TIPS procedures.
Importantly, the development of AKI had serious prognostic implications. Patients who developed AKI were found to have a significantly higher risk of all-cause mortality within three months after the procedure. The study also noted that AKI was associated with increased medical expenses, reflecting longer hospital stays and the need for additional interventions.
The authors concluded that AKI following TIPS is not uncommon in patients with decompensated cirrhosis and is strongly influenced by metabolic comorbidities, baseline renal function, circulatory status, and procedural factors. They emphasized that early identification of high-risk patients and careful perioperative management may help reduce the incidence of AKI and improve short-term outcomes after TIPS.
Reference:
Jia, M., Guo, YD., Ye, PP. et al. Acute kidney injury after TIPS in decompensated cirrhosis patients: a retrospective cohort study. BMC Nephrol (2025). https://doi.org/10.1186/s12882-025-04722-y
