Octreotide/midodrine therapy significantly improves survival in type 1 hepatorenal syndrome: Analysis of 53 treated patients &amp; 21 controls

Esrailian, Eric; Pantangco, Eugene R.; Kyulo, Namgyal L.; Hu, Ke–Qin; Runyon, Bruce A.

doi:10.1016/s0016-5085(03)83625-9

Cited by 8 publications

(10 citation statements)

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“…The rate of full response to midodrine/octreotide was similar to that (20.8%) reported by Cavallin, who compared the efficacy of terlipressin to that of midodrine/octreotide in a randomized controlled trial (Cavallin et al, 2015). Nevertheless, it was lower than the response (40%) observed in a previous retrospective study by Esrailian et al (2007). In order to explain this difference, it should be highlighted that more than 50% of the treated patients in the study by Esrailian (Esrailian et al, 2007) had alcoholic hepatitis, in which recovery of renal functions could have been achieved only as a result of the improvement of their liver disease.…”

Section: Discussionsupporting

confidence: 84%

Norepinephrine is More Effective Than Midodrine/Octreotide in Patients With Hepatorenal Syndrome-Acute Kidney Injury: A Randomized Controlled Trial

2021

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Background: Terlipressin is the first-line pharmacological treatment for hepatorenal syndrome. When terlipressin is unavailable, midodrine/octreotide or norepinephrine, with albumin, represent the alternative treatments. The comparative efficacy of these alternative regimens remains unclear.Objective: To compare the efficacy of midodrine/octreotide to that of norepinephrine for the treatment of patients with hepatorenal syndrome.Methods: In the intensive care setting, sixty patients with hepatorenal syndrome were randomized to initially receive either 0.5 mg/h of norepinephrine (maximum 3 mg/h) or 5 mg of oral midodrine three times/day (maximum 12.5 mg three times/day) plus octreotide (100 μg/6 h) as subcutaneous injection (maximum 200 μg/6 h), together with albumin (20–40 g/day). Treatment was allowed for a maximum of 10 days. Survival was analyzed for up to 30 days. The primary efficacy outcome was the proportion of patients who achieved full response, defined as the return of serum creatinine to a value within 0.3 mg/dl of the baseline at the end of treatment.Results: There was a significantly higher rate of full response in the norepinephrine group (15/26, 57.60%) than the midodrine/octreotide group (5/25, 20%) (p = 0.006). Eleven (42.30%) patients in the norepinephrine group and 6 (24%) in the midodrine/octreotide group survived (p = 0.166).Conclusion: Norepinephrine plus albumin is significantly more effective than midodrine and octreotide plus albumin in improving renal function in patients with hepatorenal syndrome.(ClinicalTrials.gov, identifier: NCT03455322).https://clinicaltrials.gov/ct2/show/NCT03455322?cond = Hepatorenal+Syndrome&cntry = EG&draw = 2&rank = 1.

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Section: Discussionsupporting

confidence: 84%

Norepinephrine is More Effective Than Midodrine/Octreotide in Patients With Hepatorenal Syndrome-Acute Kidney Injury: A Randomized Controlled Trial

2021

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“…Indeed, a series of recent studies have suggested that the prolonged use of vasopressin derivatives, such as ornipressin [65,66] or terlipressin [67][68][69][70][71][72][73][74][75], or of a-adrenergic agonists (noradrenaline, midodrine) [76][77][78][79] in association with the prolonged infusion of human albumin are useful in the treatment of patients with type-1 HRS. Overall, although most of the information comes from non-randomised studies, the effect of this treatment can be summarized as follows: (1) recovery of renal function is obtained in 40-60% [66][67][68][69][70][71][72][73][74][75][76][77][78], (2) the recovery of renal function is maintained in over 70-80% of patients after the treatment is withdrawn [67][68][69][70][71][72][73][74][75][76][77][78][79], (3) if recurrent HRS occurs after treatment withdrawal, re-treatment is often effective, (4) 40-50% one-month transplant-free survival can be expected [67][68]…”

Section: Therapeutic Options For Type 1 Hrsmentioning

confidence: 99%

“…To date, terlipressin is the most widely used vasoconstrictor in the treatment of type-1 HRS [67][68][69][70][71][72][73][74][75][76][77][78][79]. In several pilot studies, terlipressin has been used in more than 200 patients either as i.v.…”

Section: Therapeutic Options For Type 1 Hrsmentioning

confidence: 99%

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Pathogenesis and management of hepatorenal syndrome in patients with cirrhosis

Angeli¹,

Merkel²

2008

Journal of Hepatology

106

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Hepatorenal syndrome is a severe complication of advanced liver cirrhosis, in patients with ascites and marked circulatory dysfunction. It is clearly established that it has a functional nature, and that it is related to intense renal vasoconstriction. Despite its functional origin, the prognosis is very poor. In the present review, the most recent advances in diagnosis, pathophysiology, and treatment are discussed. Recent developments in pathophysiology are the basis of the new therapeutic strategies, which are currently under evaluation in randomised clinical trials.

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“…Liver transplantation is the treatment of choice for HRD but pharmacological treatment with albumin infusions for volume replacement is also widely recommended (1,(13)(14)(15)(16)(17)(18)(19). Volume overload with continued albumin infusions is of particular concern in cirrhotic patients.…”

Section: Codon Publicationsmentioning

confidence: 99%

Outcomes of Albumin Use in the Treatment of Acute Hepatorenal Disorders: A Single Center Experience

Pothugunta

Voora

Kramer

et al. 2017

jrenhep

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Intravenous albumin is recommended for hepatorenal disorders (HRD), but individuals who do not recover renal function may be at a high risk for pulmonary edema. We reviewed outcomes by the amount of albumin infused in 93 patients not receiving dialysis at admission but being treated with intravenous albumin for acute HRD at our institution. Absence of renal recovery was defined as no decrease in serum creatinine and requirement of dialysis during hospitalization, and partial renal recovery was defined as a decrease in serum creatinine but not to prehospitalization levels. Associations of clinical factors including total albumin infused, presence of renal recovery, and oliguria with the development of pulmonary edema during hospitalization were determined using logistic regression. Of the 93 patients, 20 patients had complete renal recovery, 17 patients had partial renal recovery, and 56 patients showed no renal recovery. Most patients received 300-600 g of albumin. Overall, 47.3% of patients developed pulmonary edema (n=44), but the risk was 75% in patients with oliguria on presentation and no renal recovery versus 17% in those with no oliguria and complete renal recovery (P<0.001). In the logistic regression model, oliguria (3.32; 95% confidence interval [CI]: 1.12, 9.81) and no renal recovery (3.38; 95% CI: 1.24, 9.16) were each associated with higher odds of pulmonary edema after adjustment for covariates. No association was noted between total albumin infused and pulmonary edema. In summary, absence of renal recovery and oliguria in patients with HRD receiving intravenous albumin is associated with a higher risk of pulmonary edema.

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Octreotide/midodrine therapy significantly improves survival in type 1 hepatorenal syndrome: Analysis of 53 treated patients & 21 controls

Cited by 8 publications

References 0 publications

Norepinephrine is More Effective Than Midodrine/Octreotide in Patients With Hepatorenal Syndrome-Acute Kidney Injury: A Randomized Controlled Trial

Norepinephrine is More Effective Than Midodrine/Octreotide in Patients With Hepatorenal Syndrome-Acute Kidney Injury: A Randomized Controlled Trial

Pathogenesis and management of hepatorenal syndrome in patients with cirrhosis

Outcomes of Albumin Use in the Treatment of Acute Hepatorenal Disorders: A Single Center Experience

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