Vasopressin, not octreotide, may be beneficial in the treatment of hepatorenal syndrome: a retrospective study

Kiser, Tyree H.; Fish, Douglas N.; Obritsch, Marilee D.; Jung, Rose; MacLaren, Robert; Parikh, Chirag R.

doi:10.1093/ndt/gfh930

Cited by 75 publications

(37 citation statements)

References 20 publications

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“…Kiser et al (100) compared vasopressin and octreotide therapy in 43 patients with type 1 HRS. Patients who were treated with vasopressin had a significantly higher HRS recovery rate and improved survival and were more likely to receive a liver transplant (100). Finally, the administration of intravenous norepinephrine in association with albumin and furosemide resulted in reversal of HRS in 10 (83%) of 12 patients with type 1 HRS, and ischemic episodes were observed in only two (104).…”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

Hepatorenal Syndrome

Wadei

Martin

Ahsan

et al. 2006

Clinical Journal of the American Society of Nephrology

229

194

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Section: Pharmacologic Treatmentmentioning

confidence: 99%

Hepatorenal Syndrome

Wadei

Martin

Ahsan

et al. 2006

Clinical Journal of the American Society of Nephrology

229

194

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“…Therapy with vasopressin, either alone or in combination with octreotide, was an independent predictor of renal function recovery (odds ratio [OR] 6.4; 95% confidence interval [CI] 1.3 -31.8). The mean vasopressin dose in patients that responded to therapy was 0.23 ± 0.19 units/min, which is significantly higher than typically utilized in shock syndromes [26]. Although patients with cirrhosis and HRS appear to be more tolerant to higher doses of vasopressin, caution and careful monitoring of serum lactate levels and the monitoring of extremities for ischemia should be maintained for patients receiving vasopressin doses >0.1 units/min as adverse effects related to vasopressin are ischemic in nature and dose dependent [27].…”

Section: Norepinephrine Versus Terlipressinmentioning

confidence: 84%

Hepatorenal Syndrome

Kiser¹

2014

IJCM

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Hepatorenal syndrome (HRS) is the most serious hepatorenal disorder and one of the most difficult to treat. To date, the best treatment options are those that reverse the mechanisms underlying HRS: portal hypertension, splanchnic vasodilation, and/or renal vasoconstriction. Therefore, liver transplantation is the preferred definitive treatment option. The role of other therapies is predominantly to prolong survival sufficiently to allow patients to undergo transplantation. Terlipressin with the addition of adjunctive albumin volume expansion is the preferred pharmacologic therapy for the treatment of patients with HRS. Norepinephrine and vasopressin are acceptable alternatives in countries where terlipressin is not yet available. For patients with Type II HRS, midodrine plus octreotide appears to be an effective pharmacologic regimen that can be administered outside of an intensive care unit setting. Regardless of chosen vasoconstrictor therapy, careful monitoring is needed to ensure tissue ischemia and severe adverse effects do not occur. Artificial hepatic support devices, renal replacement therapy, and transjugular intrahepatic portosystemic shunt (TIPS) are non-pharmacologic options for patients with HRS. However, hepatic support devices and renal replacement therapies have not yet demonstrated improved outcomes and TIPS is difficult to be employed in patients with Type I HRS due to contraindications in the majority of patients. Despite advances in our understanding of hepatorenal syndrome, the disease is still associated with significant morbidity, mortality, and costs. More evidence is urgently needed to help improve patient outcomes in this difficult-to-treat population.

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“…Although Terlipressin has been more widely studied, the wide availability of Vasopression in countries where Terlipressin is unavailable has led to its use in treatment of HRS. A summary of studies using Vasopressin and its analogs can be found in Table 2 [7][8][9][10][11][12][13][14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

A Case of Type I Hepatorenal Syndrome Treated with Vasopressin

Connor¹,

Teehan²

2013

OJNeph

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Hepatorenal syndrome (HRS) is a grave complication of end-stage liver disease and is associated with a very high mortality. This case report described a 42-year-old female with advanced alcohol-induced cirrhosis who developed HRS that was initially treated with Midodrine and Octreotide but renal function continued to deteriorate. Vasopressin therapy was added and HRS was successfully reversed. There are few data available on the use of vasopressin for HRS and this case supports its use in treatment of HRS, particularly in countries where the more widely studied Terlipressin is unavailable. This case also demonstrates that a patient failing one medical therapy for HRS may respond to an alternative or adjunctive therapy. Therefore, this should be attempted to increase the patient's chance of survival.

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Vasopressin, not octreotide, may be beneficial in the treatment of hepatorenal syndrome: a retrospective study

Abstract: When compared with OCT, HRS patients treated with AVP had significantly higher recovery rates, improved survival and were more likely to receive a liver transplant.

Cited by 75 publications

References 20 publications

Hepatorenal Syndrome

Hepatorenal Syndrome

Hepatorenal Syndrome

A Case of Type I Hepatorenal Syndrome Treated with Vasopressin

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