Pharmacological Intervention for Hepatorenal Syndrome: A Systematic Review and Meta-analysis

Nanda, Arjun; Reddy, Rewanth; Sarfraz, Humaira; Singal, Ashwani K.

doi:10.14309/00000434-201510001-02172

Cited by 9 publications

(11 citation statements)

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

Liu

Lin

et al. 2020

Adv Ther

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Background: Acute gastrointestinal bleeding (GIB) rapidly reduces effective blood volume, thereby precipitating acute kidney injury (AKI). Terlipressin, which can induce splanchnic vasoconstriction and increase renal perfusion, has been recommended for acute GIB and hepatorenal syndrome in liver cirrhosis. Thus, we hypothesized that terlipressin might be beneficial for cirrhotic patients with acute GIB and renal impairment. Methods: In this Chinese multi-center study, 1644 cirrhotic patients with acute GIB were retrospectively enrolled. AKI was defined according to the International Club of Ascites (ICA) criteria. Renal dysfunction was defined as serum creatinine (sCr) [ 133 lmol/L at admission and/or any time point during hospitalization. Incidence of renal impairment and inhospital mortality were the primary end-points.

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Section: Discussionmentioning

confidence: 99%

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

Liu

Lin

et al. 2020

Adv Ther

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“…A latest meta-analysis [ 36 ] compared terlipressin with placebo and other vasoconstrictor drugs was published on 2017, but it did not compared terlipressin with placebo and did not include the all RCTs. [ 24 , 26 ] Four new meta-analysises [ 37 – 40 ] compared the influence of different vasoactive drugs for the treatment of hepatorenal syndrome, but not just terlipressin. There was no updated meta-analysis to evaluate the effect of terlipressin for HRS.…”

Section: Discussionmentioning

confidence: 99%

Terlipressin in the treatment of hepatorenal syndrome

Wang

Liu

et al. 2018

Medicine

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Background:Hepatorenal syndrome is a fatal complication of advanced cirrhosis. Terlipressin is the most widely used treatment method, however, the therapy effects remain inconsonant. We aim to systematically assess the safety and efficacy of terlipressin for hepatorenal syndrome.Methods:We conducted a systematic review and meta-analysis. Randomized controlled trials involving terlipressin for hepatorenal syndrome were included in a systematic literature search. Two authors independently assessed the studies for inclusion and extracted the data. A meta-analysis was conducted to estimate the safety and efficacy of terlipressin for hepatorenal syndrome.Results:A total of 18 randomized controlled trials including 1011 patients were included. Hepatorenal syndrome reverse rate was 42.0% in the terlipressin group and 26.2% in the non-terlipressin group. Terlipressin had greater hepatorenal syndrome reverse rate and renal function improvement rate than placebo and octreotide in the management of HRS. Comparing to norepinephrine, terlipressin had similar efficacy, but with more adverse events. No significant difference of the efficacy was found between terlipressin and dopamine treatment. The subgroup analysis for type 1 HRS had the above same results, except that the adverse events were not significant different between norepinephrine group and terlipressin group.Conclusions:Terlipressin was superior to placebo and octreotide for reversal of hepatorenal syndrome and improving renal function, but it had no superiority comparing to norepinephrine.

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“…Without resolution of the underlying liver disease, however, relapse may occur following their discontinuation and no significant survival benefit has become apparent with these interventions in a recent meta-analysis. 44 Here, we will focus on discussing treatment for HRS type 1 since there are limited high-quality studies assessing the use of vasoconstrictors and albumin for the treatment of HRS type 2. Available data suggest that similar treatment approaches might apply to HRS type 2.…”

Section: Clinical Management Of Hrsmentioning

confidence: 99%

“…Since terlipressin is not FDA approved for use in the United States, norepinephrine is a viable alternative and it has been shown to be as effective as terlipressin at doses of 0.5 to 3 mg intravenously per hour. 44,47,48 The combination of midodrine (an alpha-1 adrenergic agonist, dose of 5-15 mg orally every 8 hours 49,50 ) and octreotide (a somatostatin analog, dose of 100-200 µg of subcutaneous octreotide every 8 hours) is also considered an acceptable alternative for patients without central venous access receiving care on the medical floors, although this combination is not considered as effective as terlipressin. 51,52 While there are no generally accepted MAP goals for the treatment of HRS, a meta-analysis of 21 studies revealed that the magnitude of blood pressure elevation with vasopressors was more important than the specific type of vasopressor used.…”

Section: Clinical Management Of Hrsmentioning

confidence: 99%

Kidney Injury and Electrolyte Abnormalities in Liver Failure

Bonavia

Singbartl

2018

Semin Respir Crit Care Med

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The liver and kidney are key organs of metabolic homeostasis in the body and display complex interactions. Liver diseases often have direct and immediate effects on renal physiology and function. Conversely, acute kidney injury (AKI) is a common problem in patients with both acute and chronic liver diseases. AKI in patients with acute liver failure is usually multifactorial and involves insults similar to those seen in the general AKI population. Liver cirrhosis affects and is directly affected by aberrations in systemic and renal hemodynamics, inflammatory response, renal handling of sodium and free water excretion, and additional nonvasomotor mechanisms. Subsequent problems, for example, worsening ascites, hyponatremia, and AKI, often complicate management of patients with chronic progressive liver disease and add to their morbidity and mortality. Thus, AKI must be carefully defined and diagnosed in patients with liver disease. The kidney also plays a pivotal role in balancing acid–base disturbances resulting from advanced liver disease, making AKI in the setting of end-stage liver disease very difficult to manage clinically. While renal dysfunction in these patients often resolves following orthotopic liver transplant, dialysis may be required as a bridge to transplantation to mitigate the metabolic disarray found in these critically ill patients.

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Pharmacological Intervention for Hepatorenal Syndrome: A Systematic Review and Meta-analysis

Cited by 9 publications

References 0 publications

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

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

Terlipressin in the treatment of hepatorenal syndrome

Kidney Injury and Electrolyte Abnormalities in Liver Failure

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