Noradrenaline vs terlipressin in the treatment of type 2 hepatorenal syndrome: a randomized pilot study

Abstract

The results of this randomized study suggest that terlipressin and noradrenaline are safe and effective in the treatment of type 2 HRS and baseline serum creatinine, urine output and urinary sodium are predictive of response. Noradrenaline is less expensive than terlipressin in the treatment of type 2 HRS (ClinicalTrials.gov, Number NCT01637454).

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

“…13,27 The results of the current study confirm findings from previous investigations showing that treatment with terlipressin and albumin is effective in improving kidney function and inducing reversal of type 2 HRS. 6,8,16,18,[28][29][30] In fact, 61% of patients treated in our study showed reversal of type 2 HRS, with marked improvement of kidney function that was associated with improvement in circulatory function. A remarkable finding, however, was the high relapse rate observed in responders.…”

“…Relapse of HRS has also been reported in a few other studies, and it appears to be more common in type 2 HRS than in type 1 HRS. 17,18 Although the pathogenic mechanism underlying this high relapse rate was not evaluated in this investigation, it could be related to a deterioration of circulatory function after suppression of vasoconstrictor treatment, with rebound activation of vasoconstrictor systems and return to kidney hypoperfusion.…”

“…Reversal of type 2 HRS, commonly defined as reduction in serum creatinine below 1.5 mg/dL during treatment, occurs in approximately two-thirds of patients treated. 16,18 However, there is little information about use of vasoconstrictors in patients with type 2 HRS in clinical practice. 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.…”

“…This treatment is generally well tolerated and reverses type 2 HRS in a large proportion of patients. [16][17][18] However, in contrast with type 1 HRS, relapse of type 2 HRS is common after treatment withdrawal. Moreover, there is no information about the effect of treatment on the evolution of patients with type 2 HRS.…”

Combination octreotide, midodrine, and albumin may improve survival in patients with hepatorenal syndrome, but the evidence is weak

“…One small pilot study (N=12) looked at the effect of norepinephrine and found norepinephrine effective. 2 One study found that norepinephrine had similar outcomes compared to terlipressin 3 . However, the use of norepinephrine on general medical wards is usually not possible, and therefore was not an option for our patient.…”