Hepatorenal Syndrome Type 1: Current Challenges And Future Prospects

Figures & data

Figure 1 Pathogenesis of hepatorenal syndrome.

Abbreviation: HRS, hepatorenal syndrome.

Figure 2 Therapeutic approach to the renal disease in cirrhotic patients.

Abbreviation: HRS, hepatorenal syndrome.

Table 1 Characteristics And Outcomes Of Published Randomized Controlled Trials Comparing Different Pharmacological Interventions For Management Of Type 1 Hepatorenal Syndrome

Study	Intervention, Number Of Patients	Control, Number Of Patients	30 Days-Mortality	Reversal Of HRS
Terlipressin vs Placebo/Control
Solanki et al,^Citation50 2003	Terlipressin 1 mg/12 h x 15d (+albumin); 12	Placebo x 15d (+albumin); 12	Terlipressin: 7/12 Placebo: 12/12	NR
Neri et al,^Citation51 2008	Terlipressin 1 mg/8h × 5d followed by 0.5 mg/8h × 14d (+albumin); 26	Albumin alone × 15d; 26	Terlipressin: 7/26 Placebo: 15/26	Terlipressin: 21/26 Placebo: 5/26
Sanyal et al,^Citation52 2008	Terlipressin 1 mg/6 h up to 2 mg/6 h × 14d (+albumin); 56	Placebo × 14d (+albumin); 56	Terlipressin: 32/56 Placebo: 35/56	Terlipressin: 19/56 Placebo: 7/56
Martin-Llahi et al,^Citation82 2008	Terlipressin 1 mg/4 h up to 2 mg/4 h × 15d (+albumin); 17	Albumin alone × 15d; 18	Terlipressin: 17/23 Placebo: 19/23	Terlipressin: 6/17 Placebo: 2/18
Zafar et al,^Citation83 2012^a	Terlipressin 1mg/4 h × 7-10d (+albumin); 25	Albumin alone × 7-10d; 25	Terlipressin: 19/25 Placebo: 20/25	Terlipressin: 10/25 Placebo: 2/25
Boyer et al,^Citation53 2016	Terlipressin 1 mg/6h up to 2 mg/6 h × 14d (+albumin); 97	Placebo × 14d (+albumin); 99	Terlipressin: 32/97 Placebo: 35/99	Terlipressin: 19/97 Placebo: 13/99
Noradrenaline vs Terlipressin
Alessandria et al,^Citation59 2007	Noradrenaline 0.1 µg/Kg/min up to 0.7 µg/Kg/min until HRS reversal or a ma×imum of 14d (+albumin); 5	Terlipressin 1 mg/4h up to 2 mg/4h × 28d; 25 until HRS reversal or a ma×imum of 14d (+albumin); 4	Noradrenaline: 1/5 Terlipressin: 1/4	Noradrenaline: 4/5 Terlipressin: 3/4
Indrabi et al,^Citation56 2013^a	Noradrenaline (dose and duration not reported) (+albumin); 30	Terlipressin (dose and duration not reported) (+albumin); 30	Noradrenaline: 29/30 Terlipressin: 28/30	Noradrenaline: 16/30 Terlipressin: 17/30
Sharma et al,^Citation57 2008	Noradrenaline 0.5 mg/h up to 3 mg/h × 15d (+albumin); 20	Terlipressin 0.5 mg/6h up to 2 mg/6 h × 15d (+albumin); 20	Noradrenaline: 9/20 Terlipressin: 9/20	Noradrenaline: 10/20 Terlipressin: 8/20
Singh et al,^Citation58 2012	Noradrenaline 0.5 mg/h up to 3 mg/h until HRS reversal or a maximum of 14d (+albumin); 23	Terlipressin 0.5 mg/6 h up to 2 mg/6h until HRS reversal or a maximum of 14d (+albumin); 23	Noradrenaline: 15/23 Terlipressin: 16/23	Noradrenaline: 10/23 Terlipressin: 9/23
Octreotide + Midodrine vs Terlipressin
Cavallin et al,^Citation55 2015	Midodrine p.o.7.5 mg/8 h up to 12.5mg/8 h + Octreotide s.c. 100 µg/8h up to 200 µg/8h until HRS reversal or a maximum of 14d (+albumin); 22	Terlipressin 3 mg/24 h up to 12 mg/24 h until HRS reversal or a maximum of 14d (+albumin); 27	Octreotide+Midodrine: 7/22 Terlipressin: 8/27	Octreotide+Midodrine: 1/22 Terlipressin: 15/27
Dopamine + Furosemide vs Terlipressin
Srivastava et al,^Citation61 2015	Dopamine 2 µg/Kg/min + Furosemide 0.01 mg/Kg/h × 5 days (+albumin); 20	Terlipressin 0.5 mg/6h × 5 days (+albumin); 20	Dopamine+Furosemide: 17/20 Terlipressin: 17/20	NR
Octreotide + Midodrine vs Noradrenaline
Tavakkoli et al,^Citation62 2012	Midodrine po 5 mg × 3/day up to 15 mg × 3/day + octreotide s.c. 100 μg/8h up to 200 μg/8h until HRS reversal or a maximum of 15d (+albumin); 9	Noradrenalin 0.1 µg/Kg/min up to 0.7 µg/Kg/min until HRS reversal or a maximum of 15d (+albumin); 6	Octreotide+Midodrine: 4/9 Noradrenaline: 4/6	Octreotide+Midodrine: 6/9 Noradrenaline: 5/6

Note: ^aData reported as congress abstracts.

Abbreviations: HRS, hepatorenal syndrome; NR, not reported.

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Zafar S, Haque I, Tayyab GU, Khan G, Chaudry N. Role of terlipressin and albumin combination versus albumin alone in hepatorenal syndrome. American Journal of Gastroenterology. 2012;107:S175–S176.

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Boyer TD, Sanyal AJ, Wong F, et al. Terlipressin plus albumin is more effective than albumin alone in improving renal function in patients with cirrhosis and hepatorenal syndrome type 1. Gastroenterology. 2016;150:1579–1589. doi:10.1053/j.gastro.2016.02.02626896734

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Indrabi RA, Javid G, Zargar SA, et al. Noradrenaline is equally effective as terlipressin in reversal of type 1 hepatorenal syndrome: a randomized prospective study. J Clin Exp Hepatol. 2013;1:S97. doi:10.1016/j.jceh.2013.02.242

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Cavallin M, Kamath PS, Merli M, et al. Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: a randomized trial. Hepatology. 2015;62:567–574. doi:10.1002/hep.v62.225644760

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