Incidence and risk factors for acute renal failure in patients with hepatocellular carcinoma undergoing transarterial chemoembolization: a prospective study

Background: Transarterial chemoembolization (TACE) is effective for hepatocellular carcinoma (HCC). Considerable amounts of radiocontrast agent are used for TACE and may induce renal dysfunction. Method: This study prospectively investigated the incidence and risk factors of acute renal failure (ARF), defined as an increase of serum creatinine level >1.5 mg/dl after TACE. Results: ARF developed in 12 (8.6%) of 140 patients after TACE. Univariate analysis showed that number of treatment sessions (2.3+/-1.4 vs 1.3+/-1.6, P=0.013), Child-Pugh class B (50% vs 21%, P=0.035) and the occurrence of severe postembolization syndrome (75% vs 30%, P=0.020) were significantly associated with the development of ARF. Multivariate logistic regression analysis disclosed that the proportional increased risk of ARF was 65% for each additional TACE therapy (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.13-2.41, P=0.010). Other independent risk factors were Child-Pugh class B (OR: 12.82, 95% CI: 2.44-67.29, P=0.003) and severe postembolization syndrome (OR: 6.64, 95% CI: 1.60-27.49, P=0.009). Four (33%) of the patients with ARF developed irreversible renal function impairment, and diabetes mellitus was the only associated factor (P=0.067) in this group. Conclusions: ARF after TACE is closely associated with number of treatment sessions, severity of cirrhosis and development of severe postembolization syndrome. Effective preventive measures should be undertaken especially in high-risk patients.