Systematic review: renal and other clinically relevant outcomes in hepatorenal syndrome trials

Tandon, P.K.; Bain, Vincent G.; Tsuyuki, Ross T.; Klarenbach, Scott

doi:10.1111/j.1365-2036.2007.03303.x

Cited by 6 publications

(4 citation statements)

References 56 publications

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“…Many studies conducted during the last decade have suggested that vasopressor therapy plus volume expansion with intravenous albumin improves the prognosis of HRS. Though these results may be subject to sampling bias because of inconsistent study inclusion criteria 26,27 prudent use of this combined therapy seems justified in type 1 HRS. In some reports, responders to vasoconstrictor plus albumin therapy had improved survival, and a significant proportion of patients were successfully bridged to liver transplantation 28–32 …”

Section: Pathophysiologymentioning

confidence: 96%

Terlipressin in hepatorenal syndrome: Evidence for present indications

Rajekar

Chawla

2011

J of Gastro and Hepatol

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Hepatorenal syndrome (HRS) is the most frequent life threatening complication of advanced liver failure and cirrhosis. HRS results from a functional renal dysfunction due to circulatory disturbances in patients with advanced liver disease and portal hypertension. Reduction in the effective circulating blood volume and hence hypoperfusion of the kidney is the basic underlying common pathogenetic mechanism for the development of hepatorenal syndrome. The prognosis for HRS remains very poor with types 1 and 2-both having an expected survival time of 2 weeks and 6 months, respectively.Although the available data are derived from studies including a limited number of patients mainly affected by type 1 HRS, vasoconstrictor drugs, in particular the vasopressin analog Terlipressin, seem to be the most effective approach for the management of HRS. Associated with albumin infusion, these drugs have been shown to lead to reduced mortality and improved renal function in HRS. Terlipressin administration significantly increases mean arterial pressure and systemic vascular resistance; while the heart rate, cardiac output, HVPG and portal venous blood flow decrease significantly. This decrease correlates well with the decrease in plasma renin activity. Thus the vasoconstrictor effect of Terlipressin reverses the basic pathology of HRS by reducing the plasma renin activity. The improvement in hemodynamics with Terlipressin is associated with an increase in glomerular filtration rate and deactivation of the vasoconstrictor and sodium-conserving hormones with reduced activity of the RAAS resulting in increased natriuresis.Terlipressin thus reverses HRS and is useful in bridging the patient to liver transplantation and may hence indirectly improve survival. Patients with HRS who show an improvement in renal function with Terlipressin and albumin seem to have an excellent posttransplantation outcome similar to that of patients without HRS. Thus, the use of Terlipressin has been shown to be safe, with minimal side effects that usually disappear after dose reduction, and results in an improved outcome in patients with HRS. Key words Conflict of interestNo conflict of interest to disclose.Hepatorenal Syndrome (HRS) was first recognized in cirrhosis by Hecker and Sherlock in 1956. 1 All nine of their patients died, with postmortem examination of the kidneys showing normal histology. They proposed that HRS is caused by a reduction in renal perfusion secondary to systemic arterial vasodilation.HRS is now increasingly being recognized as a form of renal dysfunction in the setting of liver failure. It is the most frequent fatal complication of cirrhosis with nearly 50% of patients dying within 2 weeks of this diagnosis.2 Development of ascites in patients with MELD scores of Յ10 is associated with an 8% and 11% risk of HRS at 1 and 5 years, respectively.3 At a MELD score of 18 or more nearly 40% of patients are expected to develop HRS within a year. 4 HRS has also been seen in 30% of patients with severe acute alcoholic hepatitis a...

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Section: Pathophysiologymentioning

confidence: 96%

Terlipressin in hepatorenal syndrome: Evidence for present indications

Rajekar

Chawla

2011

J of Gastro and Hepatol

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“…[1] Chances of occurrence of HRS in patients with cirrhosis of liver is 18 and 39% at one and five years respectively. [2] Based on clinical features and prognosis HRS is classified into two types. Type 1 HRS is the most common and severe variety, characterized by acute onset and rapid progression with mean survival period of two weeks after the onset of renal failure.…”

Section: Introductionmentioning

confidence: 99%

“…[1–3] Although liver transplantation remains the final and treatment of choice for type 1 HRS; pharmacological treatment acts as a bridging therapy to transplantation. [2] Use of vasoconstrictors like terlipressin and plasma expander albumin in HRS was a breakthrough pharmacological intervention. Combination of terlipressin and albumin is found to be most efficacious in improving renal function in these patients.…”

Section: Introductionmentioning

confidence: 99%

“…2010, others have mainly focused on the renal function improvement or HRS reversal efficacy of terlipressin. [24] With an aim to address the issues of non-responders to terlipressin and long term survival benefits of terlipressin, present meta-analysis differs from meta-analysis by Gludd et al . 2010, in that we specifically analyzed survival benefits of terlipressin against individual causes of death apart from analyzing overall survival benefits against all causes of death.…”

Section: Introductionmentioning

confidence: 99%

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Survival benefits of terlipressin and non-responder state in hepatorenal syndrome: A meta-analysis

Hiremath

Ld²

2013

Indian J Pharmacol

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Objectives:Terlipressin improves renal function in hepatorenal syndrome (HRS) is a known fact. However the reason for lack of its long-term survival benefits despite improvement in renal function remains unclear. The aim of this study was to analyze the survival benefits of terlipressin in HRS and to address the issue of non-responder state to terlipressin.Materials and Methods:Electronic databases and relevant articles were searched for all types of studies related to HRS and use of terlipressin in HRS. Reduction in all-cause mortality rate was the primary outcome measure. Reduction in mortality rate due to HRS and other causes of death were also analyzed.Results:With total 377 patients analyzed from eight eligible studies; terlipressin reduced all-cause mortality rate by 15% (Risk Difference: -0.15%, 95% CI:-0.26 to -0.03). Reduction in the mortality rate due to HRS at three months was 9% (Risk Difference:-0.09%, 95% CI:-0.18 to 0.00).Conclusion:Terlipressin has long term survival benefits perhaps at least up to three months but only with HRS as a cause of death not for other causes of death. Benefits and role of antioxidants like N- Acetylcysteine (NAC) in non-responder patients’ needs to be studied further. Long-term use of low dose terlipressin (<4mg/d) plus albumin and addition of antioxidant NAC to this regimen may help in improving both HRS reversal rate and survival rate in non-responders to terlipressin.

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Transjugular intrahepatic portosystemic shunt for hepatorenal syndrome: A systematic review and meta-analysis

Song

Rössle

et al. 2018

Digestive and Liver Disease

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Systematic review: renal and other clinically relevant outcomes in hepatorenal syndrome trials

Abstract: SUMMARY BackgroundAlthough reversal of pretransplant renal dysfunction in hepatorenal syndrome reduces post-transplant complications, the overall impact on morbidity and mortality requires clarification.

Cited by 6 publications

References 56 publications

Terlipressin in hepatorenal syndrome: Evidence for present indications

Terlipressin in hepatorenal syndrome: Evidence for present indications

Survival benefits of terlipressin and non-responder state in hepatorenal syndrome: A meta-analysis

Transjugular intrahepatic portosystemic shunt for hepatorenal syndrome: A systematic review and meta-analysis

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