Midodrine in the prevention of hepatorenal syndrome type 2 recurrence: A case–control study

Alessandria, Carlo; Debernardi-Venon, W.; Carello, Monica; Ceretto, Simone; Rizzetto, M.; Marzano, Alfredo

doi:10.1016/j.dld.2008.09.014

Cited by 11 publications

(4 citation statements)

References 17 publications

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“…One study analysed midodrine administration after HRS type 2 following successful treatment with terlipressin by using a dose similar to ours; midodrine was not effective in preventing the recurrence of HRS type 2 (16).…”

Section: Discussionmentioning

confidence: 99%

Prevention of paracentesis‐induced circulatory dysfunction: midodrine vs albumin. A randomized pilot study

Appenrodt

Wolf

Grünhage

et al. 2008

Liver International

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Section: Discussionmentioning

confidence: 99%

Prevention of paracentesis‐induced circulatory dysfunction: midodrine vs albumin. A randomized pilot study

Appenrodt

Wolf

Grünhage

et al. 2008

Liver International

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“…Criteria for eligibility for study selection were: (1) involvement of human subjects with diagnosis of HRS, either Type 1 or 2, according to the definition by the International Club of Ascites 10,11 ; (2) evaluation of a vasoconstrictor for the treatment of HRS, administered for at least 72 hours; (3) documentation of the effect of treatment on kidney function by serial measurement of serum creatinine; and (4) documentation of baseline and post-treatment values of MAP. Studies conducted on recurrence of HRS were excluded 12 . Three highly cited studies were excluded because of short duration of therapy 13-15 .…”

Section: Methodsmentioning

confidence: 99%

Therapeutic Response to Vasoconstrictors in Hepatorenal Syndrome Parallels Increase in Mean Arterial Pressure: A Pooled Analysis of Clinical Trials

Velez

Nietert

2011

American Journal of Kidney Diseases

106

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Background Vasoconstrictor therapy has been advocated as treatment for hepatorenal syndrome (HRS). Our aim was to explore whether across all tested vasoconstrictors, achievement of a substantial rise in arterial blood pressure is associated with recovery of kidney function in HRS. Study Design Pooled analysis of published studies identified by electronic database search. Setting & Population Data pooled across 501 subjects from 21 studies. Selection Criteria for Studies Human studies evaluating the efficacy of a vasoconstrictor administered for ≥ 72 hours in adults with HRS Type 1 or 2. Intervention Vasoconstrictor therapy. Outcomes & Measurements Cohorts’ mean arterial pressure (MAP), serum creatinine, urinary output and plasma renin activity (PRA) at baseline and at subsequent time points during treatment. Linear regression models were constructed to estimate the mean daily change in MAP, serum creatinine, urinary output and PRA for each study subgroup. Correlations were used to assess for association between variables. Results An increase in MAP is strongly associated with a decline in serum creatinine but not associated with an increase in urinary output. The associations were stronger when analyses were restricted to randomized clinical trials and were not limited to cohorts with either lower baseline MAP or lower baseline serum creatinine. The majority of the studies tested terlipressin as vasoconstrictor, whereas fewer studies tested ornipressin, midodrine, octreotide or norepinephrine. Excluding cohorts of subjects treated with terlipressin or ornipressin did not eliminate the association. Furthermore, a fall in PRA correlated with improvement in kidney function. Limitations Studies were not originally designed to test our question. We lacked access to individual patient data. Conclusions A rise in MAP during vasoconstrictor therapy in HRS is associated with improvement in kidney function, across the spectrum of drugs tested to date. These results support consideration for a goal-directed approach to the treatment of HRS.

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“…Our results are very encouraging for secondary prophylaxis of HRS-AKI; however, in view of the small number of patients enrolled, we emphasize the need for a large randomized, double-blind, multicenter trial. Alessandria et al [23] analyzed the outcome of 10 patients with hepatorenal syndrome type 2 treated successfully with terlipressin and then with midodrine (7.5-12.5 mg/tid) was compared with that of a historical control group of hepatorenal syndrome type 2 patients responders to treatment with terlipressin. They did not find any difference in the prevention of type 2 HRS, but in this study, they did not use albumin, so we cannot compare our results with the results of this study, and they enrolled type 2 HRS patients compared to our study which enrolled more severe patients of stage 2 or stage 3 of AKI.…”

Section: Discussionmentioning

confidence: 99%

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

Sharma¹,

Puri²,

Bansal³

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

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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.

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Midodrine in the prevention of hepatorenal syndrome type 2 recurrence: A case–control study

Cited by 11 publications

References 17 publications

Prevention of paracentesis‐induced circulatory dysfunction: midodrine vs albumin. A randomized pilot study

Prevention of paracentesis‐induced circulatory dysfunction: midodrine vs albumin. A randomized pilot study

Therapeutic Response to Vasoconstrictors in Hepatorenal Syndrome Parallels Increase in Mean Arterial Pressure: A Pooled Analysis of Clinical Trials

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

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