Impact of molecular adsorbent recirculating system on renal recovery in type‐1 hepatorenal syndrome patients with chronic liver failure

Lavayssière, Laurence; Kallab, Siba; Cardeau-Desangles, Isabelle; Nogier, Marie Béatrice; Cointault, Olivier; Barange, Karl; Muscari, Fabrice; Rostaing, Lionel; Kamar, Nassim

doi:10.1111/jgh.12159

Cited by 23 publications

(9 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Endotoxins can cause constriction of both renal and peripheral blood vessels, a decrease in renal blood flow, and a decline in GFR. Ultimately, this results in oliguria and azotemia [78].…”

Section: Pathogenesismentioning

confidence: 99%

Chinese guidelines on the management of ascites and its related complications in cirrhosis

Duan

Ding

et al. 2019

Hepatol Int

View full text Add to dashboard Cite

The Chinese Society of Hepatology developed the current guidelines for the Management of Ascites and Its Related Complications in Cirrhosis based on the published evidences and the panelists' consensus. The guidelines provided recommendations for the diagnosis and management of cirrhotic ascites emphasizing a step-wise approach with the first-, second-, and thirdline therapy. For refractory ascites, vasoconstrictors and albumin are recommended for splanchnic vasodilation and selective vasopressin (V2) receptor antagonists for moderate-to-severe hyponatremia. For spontaneous bacterial peritonitis, empirical anti-infection treatment was recommended based on the local microbiological examination of community-or hospitalacquired infections. For hepatorenal syndrome, the administration of vasopressor terlipressin and albumin is recommended.

show abstract

“…Endotoxins can cause constriction of both renal and peripheral blood vessels, a decrease in renal blood flow, and a decline in GFR. Ultimately, this results in oliguria and azotemia [78].…”

Section: Pathogenesismentioning

confidence: 99%

Chinese guidelines on the management of ascites and its related complications in cirrhosis

Duan

Ding

et al. 2019

Hepatol Int

View full text Add to dashboard Cite

show abstract

“…Wong et al performed a study involving six type 1 HRS patients with refractory ascites that had failed vasoconstrictor treatment [ 62 ] and found that MARS was not associated with significant improvements in the GFR, neurohormonal levels, or systemic haemodynamics. In a study of 32 patients, Lavayssière et al found that only 28% of type 1 HRS patients showed complete renal recovery after 28 days [ 63 ]. More recently, a large randomised controlled trial (RELIEF) involving 19 European centres comparing MARS with standard therapy in patients with acute-on-chronic liver failure [ 64 ] reported that while MARS provided temporary organ benefit (liver, kidney, and brain), it did not improve overall survival.…”

Section: Treatment Optionsmentioning

confidence: 99%

Hepatorenal Syndrome: Aetiology, Diagnosis, and Treatment

Low

Alexander

Lomas

2015

Gastroenterology Research and Practice

View full text Add to dashboard Cite

Acute renal impairment is common in patients with chronic liver disease, occurring in approximately 19% of hospitalised patients with cirrhosis. A variety of types of renal impairment are recognised. The most important of these is the hepatorenal syndrome, a functional renal impairment due to circulatory and neurohormonal abnormalities that underpin cirrhosis. It is one of the most severe complications of cirrhosis with survival often measured in weeks to months. A variety of treatment options exist with early diagnosis and appropriate treatment providing the best hope for cure. This paper provides a comprehensive and up-to-date review of hepatorenal syndrome and lays out the topic according to the following sections: pathophysiology, historical developments, diagnostic criteria and limitations, epidemiology, precipitating factors, predictors, clinical and laboratory findings, prognosis, treatment options, prophylaxis, and conclusion.

show abstract

“…A more recent study demonstrated that MARS was ineffective in improving systemic haemodynamics in six patients with type 1 HRS who failed vasoconstrictor treatment; only transient reduction in serum creatinine occurred [84]. Another study on 32 HRS-1 patients reported a rate of complete renal response of 28% (9/32) [85]. Prometheus employs fractional plasma separation, and adsorption with haemodialysis could be utilized to treat liver failure patients who have a need for RRT.…”

Section: Therapy Of Hrs: Dialysismentioning

confidence: 99%

Hepatorenal Syndrome and Novel Advances in its Management

Fabrizi¹,

Aghemo

Messa³

2013

Kidney Blood Press Res

View full text Add to dashboard Cite

Hepatorenal syndrome is a complication of end stage liver disease. It is a unique form of functional renal failure related to kidney vasoconstriction in the absence of underlying kidney pathology. Hepatorenal syndrome is classified into 2 types: type-1 HRS shows a rapid and progressive decline in renal function with a very poor prognosis (median survival of about 2 weeks); type-2 HRS has a more stable kidney failure, with a median survival of 6 months; its main clinical manifestation is refractory ascites. The most appropriate therapy for HRS is liver transplantation but only a minority of HRS patients undergo the procedure due to the high mortality; survival among liver transplant recipients is lower in HRS than among their counterparts without HRS. A large body of evidence, based on observational studies and randomized controlled trials, has been accumulated in the last decade showing that terlipressin represents a milestone in the management of HRS. According to our meta-analysis of randomized trials comparing terlipressin vs. placebo (five trials, n=243 patients), the pooled rate of patients who reversed HRS by terlipressin was 8.09 (95% CI, 3.52; 18.59) (P<0.001). Among vasoconstrictors, terlipressin (a V1 vasopressin agonist) is the most widely used; however, noradrenaline is another good choice. Vasoconstrictor drugs alone or with albumin reduce mortality compared with no intervention or albumin (RR of mortality, 0.82; 95% Confidence Intervals, 0.70; 0.96) (P<0.01). Two series of patients with HRS recurrence after the first treatment have recently shown that long-term therapy with terlipressin and albumin is beneficial as a bridge to liver transplant. Nevertheless, recovery of renal function can be achieved in less than 50% of patients with HRS after terlipressin use and the recovery of renal function may also be partial in patients who are defined full responders. Renal replacement therapy should not be considered a first-line therapy for HRS Clinical trials are under way in order to assess efficacy and safety of novel therapeutic agents for the treatment of type-1 and type-2 HRS.

show abstract

Impact of molecular adsorbent recirculating system on renal recovery in type‐1 hepatorenal syndrome patients with chronic liver failure

Abstract: MARS therapy improved renal function in only very few patients with HRS1. Further controlled studies including large number of patients are required.

Cited by 23 publications

References 36 publications

Chinese guidelines on the management of ascites and its related complications in cirrhosis

Chinese guidelines on the management of ascites and its related complications in cirrhosis

Hepatorenal Syndrome: Aetiology, Diagnosis, and Treatment

Hepatorenal Syndrome and Novel Advances in its Management

Contact Info

Product

Resources

About