Urine TIMP2.IGFBP7 reflects kidney injury after moderate volume paracentesis in patients with ascites: A randomized control study

Background Patients with cirrhosis undergoing therapeutic paracentesis are at risk of developing kidney injury, but this has not been well evaluated in a non-large volume paracentesis setting. Objective The aims of this study were to determine the risk and consequence of acute kidney injury (AKI) and its progression in patients with decompensated cirrhosis after moderate volume paracentesis by use of a urine test measuring tissue inhibitor of metalloproteinases-2 (TIMP2) and (IGFBP7). Methods A randomized, prospective cohort study was performed. All outpatients with decompensated cirrhosis with ascites and diuretic complications were enrolled and randomized into 3 liters and 5 liters of paracentesis groups. Serial urine samples were analyzed for [TIMP2]*[IGFBP7] concentration before and after paracentesis. Results A total of 90 patients with decompensated cirrhosis were consecutively enrolled during the study period. After screening, 29 patients were enrolled in the 3-liter paracentesis group, and 25 patients were enrolled in the 5-liter paracentesis group. The mean of the MELD score was 8 ± 1.2. Urine TIMP2.IGFBP7>2, rising urine TIMP2, and rising urine TIMP2/urine Cr were shown in patients within the 5-liter group for 48% (p = 0.015), 32% (p = 0.049) and 76% (p =0.010), respectively. There was no statistical difference between the two groups in the rapid decline of GFR, admission, or death. Conclusion Urine TIMP2.IGFBP7>2 predicted renal tubular injury in patients in the ascites release 5 L group therefore, ascites release 5 L may not be safe. Kidney injury could occur even less than 5 liters of ascites release in decompensated cirrhosis as demonstrated. The national clinical registration number was TCTR20191116003.