Terlipressin effect on hepatorenal syndrome: Updated meta‐analysis of randomized controlled trials

Mohamed, Mohamed M G; Rauf, Abdul; Adam, Abubakr; Kheiri, Babikir; Lacasse, Alexandre; El-Halawany, Hani

doi:10.1002/jgh3.12600

Cited by 10 publications

(8 citation statements)

References 25 publications

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“…The greatest limitation in evidence synthesis for HRS has been the small numbers of trials and events resulting in imprecision and the quality of the trials, resulting in RoB concerns. Reviewers of HRS pharmacotherapy have been consistent over the past decade in terms of direction of effect (6,7,52). However, all reviews have rated the certainty of the evidence for pharmacological therapies as low to very low.…”

Section: In Relation To Other Findingsmentioning

confidence: 99%

The Comparative Effectiveness of Vasoactive Treatments for Hepatorenal Syndrome: A Systematic Review and Network Meta-Analysis*

Pitre

Kiflen

Helmeczi

et al. 2022

Critical Care Medicine

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OBJECTIVE: Hepatorenal syndrome (HRS) is associated with high rates of morbidity and mortality. Evidence examining commonly used drug treatments remains uncertain. We assessed the comparative effectiveness of inpatient treatments for HRS by performing a network meta-analysis of randomized clinical trials (RCTs). DATA SOURCES: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Medline In-Process & Other Non-Indexed Citations, Scopus, and Web of Science from inception. STUDY SELECTION AND DATA EXTRACTION: Pairs of reviewers independently identified eligible RCTs that enrolled patients with type 1 or 2 HRS. Pairs of reviewers independently extracted data. DATA SYNTHESIS: We assessed risk of bias using the Cochrane tool for RCTs and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach. Our main outcomes are all-cause mortality, HRS reversal, and serious adverse events. Of 3,079 citations, we included 26 RCTs examining 1,736 patients. Based on pooled analysis, terlipressin increases HRS reversal compared with placebo (142 reversals per 1,000 [95% CI, >87.7 to >210.9]; high certainty). Norepinephrine (112.7 reversals per 1,000 [95% CI, 52.6 to >192.3]) may increase HRS reversal compared with placebo (low certainty). The effect of midodrine+octreotide (67.8 reversals per 1,000 [95% CI, <2.8 to >177.4]; very low) on HRS reversal is uncertain. Terlipressin may reduce mortality compared with placebo (93.7 fewer deaths [95% CI, 168.7 to <12.5]; low certainty). Terlipressin probably increases the risk of serious adverse events compared with placebo (20.4 more events per 1,000 [95% CI, <5.1 to >51]; moderate certainty). CONCLUSIONS: Terlipressin increases HRS reversal compared with placebo. Terlipressin may reduce mortality. Until access to terlipressin improves, initial norepinephrine administration may be more appropriate than initial trial with midodrine+octreotide. Our review has the potential to inform future guideline and practice in the treatment of HRS.

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Section: In Relation To Other Findingsmentioning

confidence: 99%

The Comparative Effectiveness of Vasoactive Treatments for Hepatorenal Syndrome: A Systematic Review and Network Meta-Analysis*

Pitre

Kiflen

Helmeczi

et al. 2022

Critical Care Medicine

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“…Другий механізм лікування ГРС спрямований на подолання спланхнічної вазодилатації, що досягається використанням вазоконстикторів. На сьогодні терліпресин є вазопресином з найбільш переконливими механізмами щодо успіху лікування ГРС, і, як було показано, терліпресин поліпшує ймовірність оборотного розвитку ГРС без діалізу та 10-денного виживання порівняно з плацебо (29,1 проти 15,8 %; P = 0,012) [23,24]. Можливими побічними ефектами терліпресину є діарея та біль у животі, про які повідомляється приблизно у 10-20 % пацієнтів, але більш серйозні ускладнення пов'язані із ризиком розвитку інфаркту міокарда та кишкової ішемії з частотою 2-13 %.…”

Section: обговоренняunclassified

Features of the course of hepatorenal syndrome in decompensated portal hypertension (case report)

Tutchenko,

Rudyk,

Besedinskyi

et al. 2024

GASTRO

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Hepatorenal syndrome is a critical and potentially life-threatening complication in patients with advanced liver cirrhosis, characterized by the development of renal dysfunction in the absence of underlying structural kidney disease. Despite some encouraging studies of pharmacological treatments, the development of hepatorenal syndrome in people with cirrhosis implies a poor prognosis, as renal failure is usually irreversible unless a liver transplantation is performed. The purpose is to show the peculiarities of hepatorenal syndrome and the method of its successful treatment. The article describes a clinical case of hepatorenal syndrome in the postoperative period in a 54-year-old woman who was hospitalized urgently with bleeding esophageal varices. She has a history of liver cirrhosis associated with HCV and portal vein thrombosis, portal hypertension syndrome, bleeding esophageal varices, ascites. After stabilization of hemodynamic parameters, the patient underwent a portoazygous disconnection, which included devascularization of the distal esophagus, proximal stomach, and esophageal transection. The first day of the postoperative period was complicated by the development of hepatorenal syndrome. Only its timely diagnosis in decompensated portal hypertension, with the elimination of pathophysiological components of the pathological process, allows correcting this complex pathology. When draining ascites, detoxification of the body is possible, which makes it possible to partially compensate for impaired kidney function. Albumin replacement therapy helps maintain osmotic balance.

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“…To date, terlipressin is the vasopressin with the most convincing data to date. 90 Several positive results from clinical trials have led to the United States (US) Food and Drug Administration recently approving the use of terlipressin in the US for improving kidney function in patients with HRS. Terlipressin is generally administered by IV boluses at starting doses of 0.5-1mg every 4-6 hours.…”

Section: Vasoconstrictorsmentioning

confidence: 99%

Hepatorenal syndrome: Current concepts and future perspectives

Jung¹,

Chang²

2023

Clin Mol Hepatol

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Hepatorenal syndrome (HRS), a progressive but potentially reversible deterioration of kidney function, remains a major complication in patients with advanced cirrhosis, often leading to death before liver transplantation (LT). Recent updates in the pathophysiology, definition, and classification of HRS have led to a complete revision of the nomenclature and diagnostic criteria for HRS type 1, which was renamed HRS-acute kidney injury (AKI). HRS is characterized by severe impairment of kidney function due to increased splanchnic blood flow, activation of several vasoconstriction factors, severe vasoconstriction of the renal arteries in the absence of kidney histologic abnormalities, nitric oxide dysfunction, and systemic inflammation. Diagnosis of HRS remains a challenge because of the lack of specific diagnostic biomarkers that accurately distinguishes structural from functional AKI, and mainly involves the differential diagnosis from other forms of AKI, particularly acute tubular necrosis (ATN). The optimal treatment of HRS is LT. While awaiting LT, treatment options include vasoconstrictor drugs to counteract splanchnic arterial vasodilation and plasma volume expansion by intravenous albumin infusion. In patients with HRS unresponsive to pharmacological treatment and with conventional indications for kidney replacement therapy (KRT), such as volume overload, uremia, or electrolyte imbalances, KRT may be applied as a bridging therapy to transplantation. Other interventions, such as transjugular intrahepatic portosystemic shunt, and artificial liver support systems have a very limited role in improving outcomes in HRS. Although recently developed novel therapies have potential to improve outcomes of patients with HRS, further studies are warranted to validate the efficacy of these novel agents.

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Terlipressin effect on hepatorenal syndrome: Updated meta‐analysis of randomized controlled trials

Cited by 10 publications

References 25 publications

The Comparative Effectiveness of Vasoactive Treatments for Hepatorenal Syndrome: A Systematic Review and Network Meta-Analysis*

The Comparative Effectiveness of Vasoactive Treatments for Hepatorenal Syndrome: A Systematic Review and Network Meta-Analysis*

Features of the course of hepatorenal syndrome in decompensated portal hypertension (case report)

Hepatorenal syndrome: Current concepts and future perspectives

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