Plasma Renin Activity Predicts Prognosis and Liver Disease-Related Events in Liver Cirrhosis Patients with Ascites Treated by Tolvaptan

Oswald, Leona; Nakanishi, Hiroyuki; Kurosaki, Masayuki; Kirino, Sakura; Inada, Kento; Yamashita, Koji; Hayakawa, Yuka; Sekiguchi, Shuhei; Wang, Wan; Okada, Mao; Higuchi, Masakazu; Komiyama, Yasuyuki; Takaura, Kenta; Takada, Hitomi; Kaneko, Shun; Maeyashiki, Chiaki; Tamaki, Nobuharu; Yasui, Yutaka; Tsuchiya, Kaoru; Itakura, Jun; Takahashi, Yuka; Enomoto, Nobuyuki; Izumi, Namiki

doi:10.1159/000518099

Cited by 3 publications

(3 citation statements)

References 28 publications

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“…Numerous current studies continue to associate renin with poor outcomes. In large human observational studies of cirrhosis, plasma renin levels have been found as independent risk factors for the first decompensation event, hyponatremia, hypotension, and mortality [ 57 , 69 , 73 , 74 ]. Renin levels, like Ang1–7 levels, even correlated with MELD score in a small human study [ 57 ].…”

Section: Ras In Cirrhosis Portal Htn and The Development Of A Hyperdy...mentioning

confidence: 99%

“…While plasma renin levels are not routinely measured in the clinical setting, these recent findings present an avenue for improving clinical care. However, their utility is likely confounded by the frequent use of loop diuretics, mineralocorticoid receptor antagonists, ACEi, and ARBs in this population (whether specifically for the underlying liver disease or non-hepatic co-morbidities) [ 73 , 75 ]. Clinicians would also face challenges in interpreting one-time plasma renin levels of individual patients with cirrhosis, particularly considering the predicted difficulty of standardizing reference ranges.…”

Section: Ras In Cirrhosis Portal Htn and The Development Of A Hyperdy...mentioning

confidence: 99%

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The Renin–Angiotensin System in Liver Disease

McGrath,

Wentworth

2024

IJMS

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The renin–angiotensin system (RAS) is a complex homeostatic entity with multiorgan systemic and local effects. Traditionally, RAS works in conjunction with the kidney to control effective arterial circulation, systemic vascular resistance, and electrolyte balance. However, chronic hepatic injury and resulting splanchnic dilation may disrupt this delicate balance. The role of RAS in liver disease, however, is even more extensive, modulating hepatic fibrosis and portal hypertension. Recognition of an alternative RAS pathway in the past few decades has changed our understanding of RAS in liver disease, and the concept of opposing vs. “rebalanced” forces is an ongoing focus of research. Whether RAS inhibition is beneficial in patients with chronic liver disease appears to be context-dependent, but further study is needed to optimize clinical management and reduce organ-specific morbidity and mortality. This review presents the current understanding of RAS in liver disease, acknowledges areas of uncertainty, and describes potential areas of future investigation.

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Section: Ras In Cirrhosis Portal Htn and The Development Of A Hyperdy...mentioning

confidence: 99%

Section: Ras In Cirrhosis Portal Htn and The Development Of A Hyperdy...mentioning

confidence: 99%

The Renin–Angiotensin System in Liver Disease

McGrath,

Wentworth

2024

IJMS

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“…Splanchnic and peripheral vasodilation in response to excess nitric oxide stimulate the renin-angiotensin-aldosterone and sympathetic nervous systems, triggering a number of mechanisms that further exacerbate portal hypertension. Mediators of these pathways have been directly linked to mortality in patients with cirrhosis[ 76 , 77 ]. Thus, a number of drugs which attenuate the RAAS have been evaluated with mixed results.…”

Section: Emerging Therapies To Prevent Hepatic Decompensationmentioning

confidence: 99%

Evolution of care in cirrhosis: Preventing hepatic decompensation through pharmacotherapy

Lee¹,

Saffo²

2023

World J Gastroenterol

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Cirrhosis is a leading cause of morbidity and mortality, impacting more than 120 million people worldwide. Although geographic differences exist, etiologic factors such as alcohol use disorder, chronic viral hepatitis infections, and non-alcoholic fatty liver disease are prevalent in nearly every region. Historically, significant effort has been devoted to modifying these risks to prevent disease progression. Nevertheless, more than 11% of patients with compensated cirrhosis experience hepatic decompensation each year. This transition signifies the most important prognostic factor in the natural history of the disease, corresponding to a decline in median survival to below 2 years. Over the past decade, the need for pharmacotherapies aimed at reducing the risk for hepatic decompensation has been emphasized, and non-selective beta-blockers have emerged as the most effective option to date. However, a critical therapeutic gap still exists, and additional therapies have been proposed, including statins, rifaximin, and sodium-glucose cotransporter-2 inhibitors. Based on the results of innovative retrospective analyses and small-scale prospective trials, these pharmacotherapies represent promising options, but further studies, including randomized controlled trials, are necessary before they can be incorporated into clinical use. This report highlights the potential impact of these agents and others in preventing hepatic decompensation and discusses how this paradigm shift may pave the way for guideline-directed medical therapy in cirrhosis.

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