Long-term rifaximin therapy as a primary prevention of hepatorenal syndrome

Ibrahim, El-Nobi A.; Alsebaey, Ayman; Zaghla, Hassan; Abdelmageed, Sabry Moawad; Gameel, Khalid; Abdelsameea, Eman

doi:10.1097/meg.0000000000000967

Cited by 20 publications

(17 citation statements)

References 22 publications

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“…Another retrospective study examining 145 patients with cirrhosis showed rifaximin treatment was significantly associated with prolonged overall survival and reduced risks of spontaneous bacterial peritonitis, variceal bleeding and recurrent HE . A further randomised study of rifaximin vs placebo also showed that rifaximin prevented the development of hepatorenal syndrome which in many cases develops in association with spontaneous bacterial peritonitis . Our cohort of transplant‐listed patients with decompensated cirrhosis corroborates these findings with an associated reduction in hospital readmission with complications of ascites, including spontaneous bacterial peritonitis and hepatorenal syndrome independently associated with rifaximin use.…”

Section: Discussionsupporting

confidence: 80%

“…28 A further randomised study of rifaximin vs placebo also showed that rifaximin prevented the development of hepatorenal syndrome which in many cases develops in association with spontaneous bacterial peritonitis. 29 Our cohort of transplant-listed patients with decompensated cirrhosis corroborates these findings with an associated reduction in hospital readmission with complications of ascites, including spontaneous bacterial peritonitis and hepatorenal syndrome independently associated with rifaximin use. Patients treated with rifaximin were less likely to require the need for prioritisation in this study and therefore this may have also had a bearing on any perceivable mortality difference.…”

Section: Quality Of Life In Patients With Cirrhosis and Overt He In Rsupporting

confidence: 80%

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Rifaximin reduces the incidence of spontaneous bacterial peritonitis, variceal bleeding and all‐cause admissions in patients on the liver transplant waiting list

Salehi

Tranah

Lim

et al. 2019

Aliment Pharmacol Ther

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SummaryBackgroundRifaximin reduces the risk of overt hepatic encephalopathy (HE) and is associated with significant reductions in hospitalisations and 30‐day readmissions.AimTo examine the outcomes of patients listed for liver transplantation with a diagnosis of HE on rifaximin compared to those naïve to the drug.MethodsPatient records of those listed for liver transplantation over a 2‐year period were retrospectively reviewed. Patients were included if they had at least two episodes of overt HE resulting in hospitalisation or were encephalopathic at the time of assessment.ResultsOf the 622 patients listed for transplantation, 101 had HE. Sixty‐six patients were treated with rifaximin and 35 were naïve at listing. The use of concurrent lactulose was not significantly different between groups. Median MELD score was similar (15 [14‐16)] rifaximin‐treated and 16 [14‐18] rifaximin‐naïve). Patients on the waiting list treated with rifaximin had reduced all‐cause admissions, episodes of spontaneous bacterial peritonitis and variceal bleeding. Mean length of stay was 9 days (95% CI 6‐12) in the rifaximin‐treated group vs 14 (95% CI 7‐21) in the rifaximin‐naïve group. Multivariate regression analysis demonstrated that rifaximin was independently associated with an increase in average days to readmission (adjusted effect estimate 71, 95% CI 3‐140 days) and reduced likelihood of requirement for prioritisation on the waiting list (odds ratio 0.29; 95% CI 0.89‐0.93).ConclusionRifaximin prescribed for HE in patients listed for liver transplantation improved outcomes with significant reduction in admissions related to spontaneous bacterial peritonitis, ascites and variceal bleeding.

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Section: Discussionsupporting

confidence: 80%

Section: Quality Of Life In Patients With Cirrhosis and Overt He In Rsupporting

confidence: 80%

Rifaximin reduces the incidence of spontaneous bacterial peritonitis, variceal bleeding and all‐cause admissions in patients on the liver transplant waiting list

Salehi

Tranah

Lim

et al. 2019

Aliment Pharmacol Ther

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“…Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Yassin Abdel-Ghafar street, Shebeen El-Kom, Menoufia 32511, Egypt. 2 Radiology Department, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt. 3 National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, TIPS was rapidly applied to the treatment of many of the complications of portal hypertension when the shunt could be placed with relative ease. These complications include active bleeding of gastro-esophageal varices, control of refractory cirrhotic ascites and hepatic hydrothorax, and treatment of hepatorenal failure and hepato-pulmonary syndrome [1,2]. Hepatic encephalopathy (HE) is a well-known complication of patients with liver cirrhosis after TIPS; its pathogenesis is not well understood [3,4].…”

Section: Introductionmentioning

confidence: 99%

The association between character of portal blood flow and post-TIPS incidence of hepatic encephalopathy

Elshazly¹,

Abdel‐Samiee²,

Tharwa³

et al. 2020

Egypt Liver Journal

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Background: Hepatic encephalopathy (HE) is one of the serious complications observed post-TIPS operations in patients with different complications of portal hypertension such as refractory ascites, refractory hydrothorax, bleeding varices, and hepato-renal syndrome. Herein, we aimed to clarify predisposing factors for post-TIPS incidence of HE according to pre-TIPS hemodynamics. Results: Fifty patients were enrolled in this study with different complications of portal hypertension; most of them have Child A and B scores. Patients were evaluated by ultrasound Doppler for the flow inside the portal vein and clinically recorded into two groups: group 1, 31 patients with hepatopetal flow; and group 2, 19 patients with hepatofugal flow. Then, TIPS was performed and patients were reassessed 1 month later to detect HE. Multiple variables such as age, gender, etiology of liver disease, and indication for TIPS had no significant differences. The incidence of HE post-TIPS was observed more at group 1 more than at group 2 (P = 0.02). Conclusions: Post-TIPS incidence of HE was interestingly related to pre-TIPS flow in the portal vein (hepatopetal group more than hepatofugal group). Patients with hepatofugal flow in the portal vein are perfect candidate for TIPS than patients with hepatopetal flow in the portal vein. Patients with previous history of HE are contraindicated for TIPS except as a bridge for liver transplantation.

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“…105 Rifaximin has been shown to reduce the incidence of HRS AKI, and additional studies have investigated the effect of administration to patients with cirrhosis and ascites, and these have shown that the overall blood urea nitrogen and serum creatinine concentrations were statistically significantly lower in the rifaximin group compared with the control group who received standard medical care. 106 Rifaximin also may decrease the plasma concentrations of interleukin 6, tumor necrosis factor-a, and endotoxins, which play a crucial role in the development of SBP and HRS AKI. 107…”

Section: Experimental Agentsmentioning

confidence: 99%

Epidemiology, Pathophysiology, and Management of Hepatorenal Syndrome

Amin

Alabsawy

Jalan

et al. 2019

Seminars in Nephrology

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Acute kidney injury (AKI) is a common presentation in patients with advanced cirrhosis hospitalized with acute decompensation. A new revised classification now divides AKI in cirrhotic patients into two broad subgroups: hepatorenal syndrome AKI (HRS AKI) and non−hepatorenal syndrome AKI (non-HRS AKI). HRS AKI represents the end-stage complication of decompensated cirrhosis with severe portal hypertension and is characterized by worsening of renal function in the absence of prerenal azotemia, nephrotoxicity, and intrinsic renal disease. Non-HRS AKI may be caused by prerenal hypoperfusion, bile acid nephropathy, nephrotoxicity, or acute parenchymal insult. There have been several mechanisms proposed to explain the pathophysiology of HRS AKI and non-HRS AKI, and a number of biomarkers have been suggested to aid in differentiation between these types of AKI and to act as prognostic indicators. The standard of care clinical management for patients with HRS AKI is to exclude other etiologies of AKI, followed by volume expansion with human albumin solution and then the introduction of vasopressors. However, some 40% of patients treated for HRS AKI fail to respond. In this review, we discuss the current and recent data about classification, pathophysiology, and management of AKI in general, with specific insight about the treatment of HRS AKI.

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Long-term rifaximin therapy as a primary prevention of hepatorenal syndrome

Abstract: Rifaximin may be useful as a primary prevention of HRS.

Cited by 20 publications

References 22 publications

Rifaximin reduces the incidence of spontaneous bacterial peritonitis, variceal bleeding and all‐cause admissions in patients on the liver transplant waiting list

Rifaximin reduces the incidence of spontaneous bacterial peritonitis, variceal bleeding and all‐cause admissions in patients on the liver transplant waiting list

The association between character of portal blood flow and post-TIPS incidence of hepatic encephalopathy

Epidemiology, Pathophysiology, and Management of Hepatorenal Syndrome

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