Improvement of hepatorenal syndrome with extracorporeal albumin dialysis mars: Results of a prospective, randomized, controlled clinical trial

Mitzner, Steffen; Stange, Jan; Klammt, Sebastian; RISLER, T; ERLEY, C; BADER, B; BERGER, E; LAUCHART, W; Peszynski, P.; FREYTAG, J

doi:10.1053/lv.2000.6355

Cited by 560 publications

(168 citation statements)

References 17 publications

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“…[85][86][87] In a small clinical trial, extracorporeal liver support with the molecular adsorbents recirculation system was shown to improve both kidney function and to extend survival in advanced cirrhosis with established HRS; however, confirmatory data are pending. 88 In progressive HRS, extracorporeal RRT in eligible patients can be used to support loss of kidney function and as a bridge until liver transplantation.…”

Section: Secondary Cardio-renal Syndromes (Type 5 Crs)mentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

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Section: Secondary Cardio-renal Syndromes (Type 5 Crs)mentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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“…23 The probability of survival was significantly higher in the 'MARS' group than in the 'hemofiltration-alone' group (median survival was 10 days and 4 days, respectively). It is very important to note that values for median survival were shorter than the median survival of 12 days found in another study in untreated patients with HRS.…”

Section: Renal Replacement Therapymentioning

confidence: 90%

Hepatorenal syndrome in patients with cirrhosis

Moreau

2002

J of Gastro and Hepatol

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Type 1 hepatorenal syndrome (HRS) is a severe complication of end-stage cirrhosis. Type 1 HRS is an acute functional renal failure (i.e. glomerular hypofiltration) with no other explanation than the presence of the circulatory and neurohumoral alterations associated with severe chronic liver disease. Plasma volume expansion does not improve renal function. In contrast, administration of the vasopressin analog terlipressin, a splanchnic and systemic vasoconstrictor, may improve renal function and be used while awaiting liver transplantation. © 2002 Blackwell Publishing Asia Pty LtdKey words : cirrhosis, renal failure, vasoconstrictors. DEFINITIONS AND DIAGNOSISHepatorenal syndrome (HRS) is a renal failure which complicates end-stage cirrhosis with ascites. [1][2][3][4][5] There are two clinical types of HRS: type 1 and 2. 2 Type 1 HRS is characterized by the development of acute renal failure; that is, a doubling of initial serum creatinine to levels above 130 µ mol/L or a 50% decrease in the initial 24-h creatinine clearance to below 20 mL/min in less than 2 weeks. 2 Patients with type 1 HRS are in poor condition. Type 2 HRS is characterized by moderate and stable renal failure in patients who have a better condition than those with type 1 HRS. 2 This review will focus on the mechanisms, diagnosis, prognosis and treatment of type 1 HRS, and the term HRS will be used instead of type 1 HRS.Information on the frequency of HRS is controversial. In a large North American study of 3860 patients with ascites, HRS was diagnosed in less than 1% of patients. 6 Another study of 234 non-azotemic patients with ascites showed that the probability of developing HRS was 20% and 40% at 1 and 5 years, respectively. 7

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“…Although conventional dialysis has not been shown to be effective in the treatment of HRS, 117,118 the use of albuminenriched dialysate fluid seems to help in the management of HRS. In a randomized controlled trial of MARS-assisted dialysis versus conventional hemodialysis and standard medical therapy, 119 the patients who received MARS-assisted dialysis had a significant reduction in serum bilirubin and creatinine (from 3.8 Ϯ 1.6 mg/dL to 2.3 Ϯ 1.5 mg/dL) that was associated with a prolongation of survival; however, survival was still low (40%) at 2 weeks. Although hemodynamic measurements were not performed, mean arterial pressure did not change in the MARS patients.…”

Section: Moleculular Adsorbent Recirculating Systemmentioning

confidence: 99%

New challenge of hepatorenal syndrome: Prevention and treatment

Wong¹

2001

Hepatology

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Hepatorenal syndrome (HRS) remains one of the major therapeutic challenges in hepatology today. The pathogenesis is complex, but the final common pathway seems to be that sinusoidal portal hypertension, in the presence of severe hepatic decompensation, leads to splanchnic and systemic vasodilatation and decreased effective arterial blood volume. Renal vasoconstriction increases concomitantly, renal hemodynamics worsens, and renal failure occurs. Renal failure was shown 15 years ago to be potentially reversible after liver transplantation. This potential reversibility together with increased understanding of the pathogenesis has led to successful preliminary attempts to reverse HRS nonsurgically with combinations of splanchnic vasoconstrictors and colloid volume expansion, insertion of transjugular intrahepatic portovenous shunt radiologically, and improved forms of dialysis. Recent classification of HRS into the acute onset or severe type 1 with virtually 100% mortality and the more insiduous less severe type II promises to shed more light on the pathogenesis of HRS, especially on the currently unrecognized precipitating factors. It is hoped that this classification will be included in the necessary and carefully performed clinical trials, which should lead to clearer indications for the available therapies. The challenge now is to use all this information to improve our management of cirrhotic patients to prevent occurrence of HRS in the future. (HEPATOLOGY 2001;34:1242-1251.)Progressive oliguric renal failure is a common and severe complication in patients with advanced liver disease. In a large prospective follow-up study of cirrhotic patients with ascites, development of renal failure occurred in 18% and 39% of the patients at 1 year and at 5 years, respectively, with a median survival of 1.7 weeks or a 90% mortality at 10 weeks. 1 Hepatorenal syndrome (HRS) originally referred to occurrence of renal failure following biliary surgery. 2 The definitions of HRS gradually evolved to describe the renal failure observed in patients with liver failure associated with low urinary sodium levels and absence of renal pathology. 3 A recent consensus conference further defined HRS as types I and II with the following diagnostic criteria: type I HRS is characterized by rapidly progressive renal failure with a doubling of serum creatinine to a level greater than 2.5 mg/dL or a halving of the creatinine clearance to less than 20 mL/min in less than 2 weeks; type II HRS is a more chronic form with a slowly progressive increase in serum creatinine level to greater than 1.5 mg/dL or a creatinine clearance of less than 40 mL/min 4 and has a corresponding better prognosis. Until recently, liver transplantation was the only definitive treatment for HRS. 5,6 However, even then, the reported survival rates of these HRS patients posttransplantation have been less than in transplanted patients with normal renal function, and the return of renal function to normal may be delayed for months or years. 7,8 Furthermore, liver transplanta...

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Improvement of hepatorenal syndrome with extracorporeal albumin dialysis mars: Results of a prospective, randomized, controlled clinical trial

Cited by 560 publications

References 17 publications

Review article: Acute kidney injury in critical illness

Review article: Acute kidney injury in critical illness

Hepatorenal syndrome in patients with cirrhosis

New challenge of hepatorenal syndrome: Prevention and treatment

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