Diagnosis, treatment and survival of patients with hepatorenal syndrome: A survey on daily medical practice

Salerno, Francesco; Cazzaniga, M.; Merli, Manuela; Spinzi, Giancarlo; Saibeni, Simone; Salmi, Andrea; Fagiuoli, Stefano; Spadaccini, A.; Trotta, E.; Laffi, Giacomo; Koch, Maurizio; Riggio, Oliviero; Boccia, S.; Felder, Martina; Balzani, S.; Bruno, Savino; Angeli, Paolo

doi:10.1016/j.jhep.2011.03.012

Cited by 87 publications

(87 citation statements)

References 28 publications

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“…24 In other studies, incidence ranges from 3.5 to 7 patients/year. 6,[24][25][26] The relatively low frequency of type 2 HRS in our patient population is in keeping with data from these previous reports. There are several studies indicating that treatment with vasoconstrictors, either terlipressin or noradrenaline, together with IV albumin improves kidney function in patients with type 2 HRS.…”

Section: Discussionsupporting

confidence: 92%

“…To our knowledge, there is only 1 survey about treatment of HRS in regular clinical practice that was made in 21 internal medicine or gastroenterology units in Italy. 26 According to this study, 72% of patients who were diagnosed with type 2 HRS were treated with vasoconstrictors, either terlipressin or midodrine, and albumin. Nevertheless, in contrast with treatment of type 1 HRS, the use of vasoconstrictors and albumin in type 2 HRS is controversial because possible beneficial effects of treatment on patient's outcome have not been investigated.…”

Section: Discussionmentioning

confidence: 96%

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Treatment of type 2 hepatorenal syndrome in patients awaiting transplantation: Effects on kidney function and transplantation outcomes

et al. 2015

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There is little information on the effects of treatment with vasoconstrictors plus albumin in patients with type 2 hepatorenal syndrome (HRS), particularly those awaiting liver transplantation (LT). This study reports the effects of treatment of type 2 HRS in patients on the waiting list for LT. We included 56 patients with type 2 HRS who were awaiting LT. Out of these 56 patients, 31 were treated with terlipressin and albumin. Nineteen (61%) of these 31 patients had response to therapy, and 11 of them relapsed after treatment withdrawal. There were no differences in mortality on the waiting list between responders and nonresponders. Among the 46 (82%) patients who underwent transplantation, 15 underwent transplantation with reversal of type 2 HRS, whereas the remaining 31 underwent transplantation with type 2 HRS. There were no significant differences in serum creatinine or estimated glomerular filtration rate between the 2 cohorts of patients at 3, 6, and 12 months after transplantation. There were no significant differences regarding development of acute kidney injury, need for renal replacement therapy, frequency of chronic kidney disease 1 year after transplant, length of hospitalization, and survival. In conclusion, treatment of patients with type 2 HRS with terlipressin and albumin does not appear to have beneficial effects either in pretransplantation or in posttransplantation outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 96%

Treatment of type 2 hepatorenal syndrome in patients awaiting transplantation: Effects on kidney function and transplantation outcomes

et al. 2015

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“…Our observations regarding factors predictive of HRS reversal and survival essentially confirm what has been observed in previous studies,22, 23, 24, 25, 26, 27 with the exception of the absence of a precipitating cause for HRS‐1, absence of prior rifaximin use in the terlipressin group, and male sex in the placebo group – all new observations. The absence of prior rifaximin use as a factor predictive of HRS reversal in the terlipressin group is of interest; it is possible that patients without prior rifaximin exposure are less ill than those receiving rifaximin.…”

Section: Discussionsupporting

confidence: 89%

Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT‐0401 and REVERSE randomised clinical studies

Sanyal

Boyer

Frederick

et al. 2017

Aliment Pharmacol Ther

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SummaryBackgroundThe goal of hepatorenal syndrome type 1 (HRS‐1) treatment is to improve renal function. Terlipressin, a synthetic vasopressin analogue, is a systemic vasoconstrictor used for the treatment of HRS‐1, where it is available.AimTo compare the efficacy of terlipressin plus albumin vs. placebo plus albumin in patients with HRS‐1.MethodsPooled patient‐level data from two large phase 3, randomised, placebo‐controlled studies were analysed for HRS reversal [serum creatinine (SCr) value ≤133 μmol/L], 90‐day survival, need for renal replacement therapy and predictors of HRS reversal. Patients received intravenous terlipressin 1–2 mg every 6 hours plus albumin or placebo plus albumin up to 14 days.ResultsThe pooled analysis comprised 308 patients (terlipressin: n = 153; placebo: n = 155). HRS reversal was significantly more frequent with terlipressin vs. placebo (27% vs. 14%; P = 0.004). Terlipressin was associated with a more significant improvement in renal function from baseline until end of treatment, with a mean between‐group difference in SCr concentration of −53.0 μmol/L (P < 0.0001). Lower SCr, lower mean arterial pressure and lower total bilirubin and absence of known precipitating factors for HRS were independent predictors of HRS reversal and longer survival in terlipressin‐treated patients.ConclusionsTerlipressin plus albumin resulted in a significantly higher rate of HRS reversal vs. albumin alone in patients with HRS‐1. Terlipressin treatment is associated with improved renal function. (ClinicalTrials.gov identifier: OT‐0401, NCT00089570; REVERSE, NCT01143246).

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“…Several randomised [52][53][54][55][56] and non-randomised 51,57,58 clinical trials have shown that terlipressin and HA improve renal function and that full reversal of type 1 HRS is obtained in up to 40-50% of patients. Although responders survive longer than non-responders, the overall survival was not significantly superior in patients receiving terlipressin plus HA than in those treated with HA alone or placebo 52,53,57 . Nevertheless, a recent metaanalysis showed that the combined treatment is also able to improve short-term survival 59 .…”

Section: Albumin For the Treatment Of Type 1 Hepatorenalmentioning

confidence: 99%

AISF-SIMTI Position Paper: The appropriate use of albumin in patients with liver cirrhosis

Caraceni¹,

Angeli²,

Prati³

et al. 2016

Digestive and Liver Disease

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Diagnosis, treatment and survival of patients with hepatorenal syndrome: A survey on daily medical practice

Cited by 87 publications

References 28 publications

Treatment of type 2 hepatorenal syndrome in patients awaiting transplantation: Effects on kidney function and transplantation outcomes

Treatment of type 2 hepatorenal syndrome in patients awaiting transplantation: Effects on kidney function and transplantation outcomes

Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT‐0401 and REVERSE randomised clinical studies

AISF-SIMTI Position Paper: The appropriate use of albumin in patients with liver cirrhosis

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