Effect of terlipressin on renal function in cirrhotic patients with acute upper gastrointestinal bleeding

Abstract

Background: Renal dysfunction is a serious morbidity in cirrhotic patients with acute upper gastrointestinal bleeding (AUGIB). Terlipressin is the first-line treatment choice for acute variceal bleeding and hepatorenal syndrome (HRS). This study aimed to assess the effect of terlipressin on renal function in patients with liver cirrhosis and AUGIB.Methods: We retrospectively reviewed 40 cirrhotic patients with AUGIB treated with terlipressin by an attending physician between January 2016 and June 2018. We analyzed the change of renal function parameters, including cystatin C (CysC) and creatinine (Cr), during the use of terlipressin and after terlipressin was stopped. We also identified the factors associated with renal function improvement in patients without active bleeding during the use of terlipressin.Results: During the use of terlipressin, CysC value was significantly reduced (1.3±0.8 vs. 1.1±0.7, P=0.001); Cr value was reduced, but the reduction was not statistically significant (68.8±24 vs. 65.5±23, P=0.817); the rate of CysC reduction was significantly higher in patients treated with terlipressin than those treated with somatostatin/octreotide (73.1% vs. 0%, P=0.005); the rate of Cr reduction was not significantly different between patients treated with terlipressin and somatostatin/octreotide (61.5% vs. 20%, P=0.148); no factor associated with CysC reduction was identified; higher hemoglobin, red blood cell, and platelet and lower prothrombin time and international normalized ratio at baseline were significantly associated with Cr reduction. After terlipressin was stopped, neither CysC nor Cr value was significantly reduced (P=0.852 and P=0.296).Conclusions: Terlipressin may be beneficial on preventing renal function impairment in cirrhotic patients with AUGIB.

Terlipressin May Decrease In-Hospital Mortality of Cirrhotic Patients with Acute Gastrointestinal Bleeding and Renal Dysfunction: A Retrospective Multicenter Observational Study

“…However, previous studies have never explored the effect of terlipressin on renal function parameters in such patients. Considering that terlipressin has been widely used for improving renal function in patients with HRS [34], it might be beneficial in cirrhotic patients with acute GIB and renal dysfunction [35]. By contrast, somatostatin and octreotide seemed to be ineffective or detrimental to renal function in healthy subjects and cirrhotic patients [12][13][14][15].…”

Efficacy and Safety of Treatments for Patients With Portal Hypertension and Cirrhosis: A Systematic Review and Bayesian Network Meta-Analysis

“…β-blockers such as propranolol and nadolol have been used for more than 30 years (5). Terlipressin and somatostatin are potent splanchnic vasoconstrictors that also have systemic circulatory effects; they increase arterial pressure and systemic vascular resistance, inhibit glucagon and other vasoactive peptides, and facilitate adrenergic vasoconstriction (68,69). Our meta-analysis showed that simple conservative treatment offers little benefit.…”

The pharmacodynamic effect of terlipressin versus high-dose octreotide in reducing hepatic venous pressure gradient: a randomized controlled trial

“…Furthermore, the long- acting octreotide had no significant hemodynamic benefits in treating portal hypertension (20). Recent studies demonstrated that the continuous infusion of terlipressin stably reduced portal pressure with less HR and MAP fluctuations than traditional bolus infusion and prevented renal impairment (21,22). This study had several limitations.…”