Midodrine and albumin versus albumin alone for the secondary prophylaxis of acute kidney injury in a patient with cirrhosis and ascites

Abstract

Background Acute kidney injury (AKI) in a patient with cirrhosis has high short-term mortality. Midodrine has shown promising results in the treatment of AKI-hepatorenal syndrome (HRS-AKI). Aims To compare midodrine and albumin versus albumin alone for the secondary prophylaxis of HRS-AKI. Patients and method Open labeled, nonrandomized, pilot study. Patients with a diagnosis of HRS-AKI were recruited after complete recovery. Patients were given midodrine daily (15 mg) and injection albumin infusion 20 g weekly in group-A (Gp-A) and injection albumin 20 g weekly with no midodrine in group-B (Gp-B). The primary endpoint was the recurrence of AKI-HRS, and the secondary endpoint was ascites tap in 2-month period. Results A total of 42 patients were enrolled in Gp-A, n = 22, and Gp-B, n = 20. There was no significant difference between the groups (Gp-A vs. Gp-B) in terms of age, model stage liver disease, Child–Turcotte–Pugh score and serum creatinine at inclusion (1.27 ± 0.1 vs. 1.22 ± 0.2 mg/dL). During follow up ten patients (50%) in Gp-B and four patients (18%) in Gp-A develop HRS-AKI (P = 0.04). The mean number of ascites tap was significantly higher in Gp-B compared to Gp-A (2.6 ± 0.5 vs. 1.9 ± 0.5) in 2 months. There was a significant increase in mean arterial pressure in Gp-A compared to Gp-B on days 7, 15, 30, 45 and 60. There was a significant difference in mean arterial pressure at day 7 in patients who developed HRS-AKI versus those who did not develop HRS-AKI [(n = 14, 65.5 ± 5.5) vs. (n = 28,74.6 ± 9.2 mm Hg), P = 0.02]. Conclusions Midodrine along with albumin infusion, is helpful in the secondary prophylaxis of HRS-AKI and reduces the number of ascites tap. However, a large randomized study is required for further validation.

Early Diagnosis and Prevention of Infections in Cirrhosis

“…Studies on long-term HAS administration have shown variable results [72,[91][92][93][94]. Long-term HAS administration (for outpatients) can prevent SBP and non-SBP related infections and reduce the incidence of kidney dysfunction [72,94,95]. Long-term HAS can also prevent hospital admissions, ascites recurrence, and prolong survival [72,91,92,94].…”

“…72 91 92 93 94 Long-term HAS administration (for outpatients) can prevent SBP- and non-SBP–related infections and reduce the incidence of kidney dysfunction. 72 94 95 Long-term HAS can also prevent hospital admissions, ascites recurrence, and prolong survival. 72 91 92 94 In addition, long-term albumin administration has an immunomodulatory effect in patients with decompensated cirrhosis.…”