Advances in management of hepatorenal syndrome

Khemichian, Saro; Francoz, Claire

doi:10.1097/mnh.0000000000000730

Cited by 3 publications

(3 citation statements)

References 48 publications

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“…In 2007-2008, multiple randomized control trials on terlipressin were published and have influenced the medical management HRS as well as patient outcomes[ 9 - 11 , 14 , 15 ]. Studies have shown potential beneficial effects of terlipressin, a potent selective splanchnic and extrarenal vasoconstrictor, on kidney function among patients with HRS[ 10 , 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample

Kaewput¹,

Dumancas²,

Kanduri³

et al. 2021

WJG

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BACKGROUND Hepatorenal syndrome (HRS) is a life-threatening condition among patients with advanced liver disease. Data trends specific to hospital mortality and hospital admission resource utilization for HRS remain limited. AIM To assess the temporal trend in mortality and identify the predictors for mortality among hospital admissions for HRS in the United States. METHODS We used the National Inpatient Sample database to identify an unweighted sample of 4938 hospital admissions for HRS from 2005 to 2014 (weighted sample of 23973 admissions). The primary outcomes were temporal trends in mortality as well as predictors for hospital mortality. We estimated odds ratios from multi-level mixed effect logistic regression to identify patient characteristics and treatments associated with hospital mortality. RESULTS Overall hospital mortality was 32%. Hospital mortality decreased from 44% in 2005 to 24% in 2014 ( P < 0.001), while there was an increase in the rate of liver transplantation ( P = 0.02), renal replacement therapy ( P < 0.001), length of hospital stay ( P < 0.001), and hospitalization cost ( P < 0.001). On multivariable analysis, older age, alcohol use, coagulopathy, neurological disorder, and need for mechanical ventilation predicted higher hospital mortality, whereas liver transplantation, transjugular intrahepatic portosystemic shunt, and abdominal paracentesis were associated with lower hospital mortality. CONCLUSION Although there was an increase in resource utilizations, hospital mortality among patients admitted for HRS significantly improved. Several predictors for hospital mortality were identified.

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Section: Discussionmentioning

confidence: 99%

In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample

Kaewput¹,

Dumancas²,

Kanduri³

et al. 2021

WJG

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“…In a retrospective study, 60 patients with hepatorenal syndrome were given midodrine, octreotide, and albumin, while 21 received only albumin. Midodrine and octreotide therapy were associated with significantly lower mortality (43 versus 71 percent) and a considerably higher proportion of patients with hepatorenal syndrome resolution (40 versus 10 percent) [ 17 ].…”

Section: Reviewmentioning

confidence: 99%

“…Because of the increased production of vasodilator factors in the advanced phase, vasodilation is more prominent and cannot be countered by an increase in cardiac output. Decreased cardiac output appears to come first in severe cirrhosis with ascites, and then hepatorenal syndrome develops [3,17,[28][29][30][31].…”

Section: Pathophysiology Of Hepatorenal Syndrome and Biomarkersmentioning

confidence: 99%

A Comprehensive Systematic Review of the Latest Management Strategies for Hepatorenal Syndrome: A Complicated Syndrome to Tackle

Roy,

Minhaz,

Shah-Riar

et al. 2023

Cureus

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Hepatorenal syndrome (HRS), defined by the extreme manifestation of renal impairment in patients with cirrhosis, is characterized by reduced renal blood flow and glomerular filtration rate. It is diagnosed with reduced kidney function confirming the absence of intrinsic kidney disease, such as hematuria or proteinuria. HRS is potentially reversible with liver transplantation or vasoconstrictor drugs. The condition carries a poor prognosis with high mortality rates, particularly in patients with advanced cirrhosis. The latest management for HRS involves a combination of pharmacological and non-pharmacological interventions, aiming to improve renal function and reduce the risk of mortality. Pharmacological treatments include vasoconstrictors, such as terlipressin and midodrine, and albumin infusion, which have been shown to improve renal function and reduce mortality in HRS patients. Non-pharmacological interventions, including invasive procedures such as transjugular intrahepatic portosystemic shunt (TIPS), plasma exchange, liver transplantation, and renal replacement therapy, may also be considered. Though TIPS has been shown to be effective in improving renal function in HRS patients, liver transplantation remains at the top of the consideration for the treatment of end-stage liver disease and HRS. Recent studies have placed importance on early recognition and prompt intervention in HRS patients, as delaying treatment can result in poorer outcomes. Although there are numerous reviews that summarize various aspects of HRS, the recent advancements in the management and pathophysiology of HRS are still insufficient. Therefore, in this review, we summarized a brief pathophysiology and highlighted recent advancements in the management of HRS with a quick review of the latest articles.

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Development and validation of prognostic nomogram for cirrhotic patients with acute kidney injury upon ICU admission

Liao,

Lu,

et al. 2023

Intern Emerg Med

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Advances in management of hepatorenal syndrome

Cited by 3 publications

References 48 publications

In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample

In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample

A Comprehensive Systematic Review of the Latest Management Strategies for Hepatorenal Syndrome: A Complicated Syndrome to Tackle

Development and validation of prognostic nomogram for cirrhotic patients with acute kidney injury upon ICU admission

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