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2013, Number 1

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Ann Hepatol 2013; 12 (1)

High age and low sodium urine concentration are associated with poor survival in patients with hepatorenal syndrome

Hinz M, Wree A, Jochum C, Bechmann LP, Saner F, Gerbes AL, Gerken G, Canbay A

Language: English
References: 42
Page: 92-99
PDF size: 140.21 Kb.


ABSTRACT

Background. Combination therapy with terlipressin and albumin substitution is considered a widely accepted treatment regimen for patients with hepatorenal syndrome (HRS). However, only half of the patients respond to treatment and to date albumin substitution and terlipressin therapy are among the most expensive medical treatments available for patients with liver diseases. Thus, we aimed to identify clinical and etiological parameters to predict treatment response and overall mortality in patients with HRS. Material and methods. We retrospectively evaluated 21 patients, 13 male/8 female, aged 43-72 years with HRS. Four patients were transplanted after following combination treatment. Terlipressin was administered by continuous intravenous perfusion (2-6 mg/d) and albumin drips (50 mg) were given daily. Treatment response was defined by a decrease in serum creatinine level to ≤ 1.5 mg/dL or by a ≥ 50% reduction of the baseline concentration. Results. 57% of the patients responded to treatment, which was associated with improved survival at day 60, compared to non-responders. However, the overall mortality was not different between the two groups. Median age of 63 years was a significant negative predictor for therapy response. High baseline urinary sodium levels were of prognostic value for survival. The Model of End stage Liver Disease score (MELD score) did not correlate with therapy response. Conclusion. In conclusion high age is a predictor of non-response. Low urinary sodium before treatment is associated with poor survival. Terlipressin and albumin co-treatment is associated with increased two-months survival rate. This seemingly moderate extension in survival rate can, however, be decisive for obtaining liver transplantation.


REFERENCES

  1. Lim JK, Groszmann RJ. Vasoconstrictor therapy for the hepatorenal syndrome. Gastroenterology 2008; 134: 1608-11.

  2. Ginès A, Escorsell A, Ginès P, Saló J, Jiménez W, Inglada L, Navasa M, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology 1993; 105: 229-36.

  3. Guevara M, Arroyo V. Hepatorenal syndrome. Expert Opin Pharmacother 2011; 12: 1405-17.

  4. Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut 2007; 56: 1310-8.

  5. Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 1996; 23: 164-76.

  6. Fernandez J, Arroyo V. Novel Definition of Hepatorenal Syndrome: Clinical Consequences. In: Gerbes AL (ed.). Frontiers of Gastrointestinal Research. Basel: KARGER; 2010, p. 122-9.

  7. Rice JP, Skagen C, Said A. Liver transplant outcomes for patients with hepatorenal syndrome treated with pretransplant vasoconstrictors and albumin. Transplantation 2011; 91: 1141-7.

  8. Arroyo V, Guevara M, Ginès P. Hepatorenal syndrome in cirrhosis: pathogenesis and treatment. Gastroenterology 2002; 122: 1658-76.

  9. Iwakiri Y, Groszmann RJ. The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule. Hepatology 2006; 43: S121-S131.

  10. Ginès P, Schrier RW. Renal failure in cirrhosis. N Engl J Med 2009; 361: 1279-90.

  11. Moreau R, Lebrec D. The use of vasoconstrictors in patients with cirrhosis: type 1 HRS and beyond. Hepatology 2006; 43: 385-94.

  12. Saner FH, Canbay A, Gerken G, Broelsch CE Pharmacology, clinical efficacy and safety of terlipressin in esophageal varices bleeding, septic shock and hepatorenal syndrome. Expert Rev Gastroenterol Hepatol 2007; 1: 207-17.

  13. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53: 397-417.

  14. Dobre M, Demirjian S, Sehgal AR, Navaneethan SD. Terlipressin in hepatorenal syndrome: a systematic review and meta-analysis. Int Urol Nephrol 2011; 43: 175-84.

  15. Sharma P, Kumar A, Shrama BC, Sarin SK. An open label, pilot, randomized controlled trial of noradrenaline versus terlipressin in the treatment of type 1 hepatorenal syndrome and predictors of response. Am J Gastroenterol 2008; 103: 1689-97.

  16. Sanyal AJ, Boyer T, Garcia-Tsao G, Regenstein F, Rossaro L, Appenrodt B, Blei A, et al. A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology 2008; 134: 1360-8.

  17. Martín-Llahí M, Pépin M-N, Guevara M, Díaz F, Torre A, Monescillo A, Soriano G, et al. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology 2008; 134: 1352-9.

  18. Alessandria C, Ottobrelli A, Debernardi-Venon W, Todros L, Cerenzia MT, Martini S, Balzola F, et al. Noradrenalin vs. terlipressin in patients with hepatorenal syndrome: a prospective, randomized, unblinded, pilot study. J Hepatol 2007; 47: 499-505.

  19. Testro AG, Wongseelashote S, Angus PW, Gow PJ. Longterm outcome of patients treated with terlipressin for types 1 and 2 hepatorenal syndrome. J Gastroenterol Hepatol 2008; 23: 1535-40.

  20. Rajekar H, Chawla Y. Terlipressin in hepatorenal syndrome: Evidence for present indications. J Gastroenterol Hepatol 2011; 26(Suppl. 1): 109-14.

  21. Nazar A, Pereira GH, Guevara M, Martín-Llahi M, Pepin MN, Marinelli M, Solá E, et al. Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology 2010; 51: 219-26.

  22. Boyer TD, Sanyal AJ, Garcia-Tsao G, Blei A, Carl D, Bexon AS, Teuber P. Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1: relationship of serum creatinine to hemodynamics. J Hepatol 2011; 55: 315-21.

  23. Alessandria C, Ozdogan O, Guevara M, Restuccia T, Jiménez W, Arroyo V, Rodés J, et al. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation. Hepatology 2005; 41: 1282-9.

  24. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003; 124: 91-6.

  25. Restuccia T, Ortega R, Guevara M, Ginès P, Alessandria C, Ozdogan O, Navasa M, et al. Effects of treatment of hepatorenal syndrome before transplantation on posttransplantation outcome. A case-control study. J Hepatol 2004; 40: 140-6.

  26. Moreau R. Hepatorenal syndrome in patients with cirrhosis. J Gastroenterol Hepatol 2002; 17: 739-47.

  27. Ginès P. Diagnosis and treatment of hepatorenal syndrome. Baillieres Best Pract Res Clin Gastroenterol 2000; 14: 945-57.

  28. Cárdenas A, Ginès P. Therapy insight: Management of hepatorenal syndrome. Nat Clin Pract Gastroenterol Hepatol 2006; 3: 338-48.

  29. Rimola A, Navasa M, Grande L, García-Valdecasas J-C. Liver Transplantation for Patients with Cirrhosis and Ascites. In: Ascites and renal dysfunction in liver disease: pathogenesis, diagnosis, and treatment. Oxford: Blackwell Pub.; 2005, p. 271-85.

  30. Gluud LL, Christensen K, Christensen E, Krag A. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 2010; 51: 576-84.

  31. Gerbes AL, Huber E, Gülberg V. Terlipressin for hepatorenal syndrome: continuous infusion as an alternative to i.v. bolus administration. Gastroenterology 2009; 137: 1179; author reply 1179-81.

  32. Angeli P. Terlipressin for Hepatorenal Syndrome: Novel Strategies and Future Perspectives. In: Gerbes AL (ed.). Frontiers of Gastrointestinal Research. Basel: KARGER; 2010, p. 189-97.

  33. Yefet E, Gershovich M, Farber E, Soboh S. Extensive epidermal necrosis due to terlipressin. Isr Med Assoc J 2011; 13: 180-1.

  34. Urge J, Sincl F, Procházka V, Urbánek K. Terlipressin-induced ventricular arrhythmia. Scand J Gastroenterol 2008; 43: 1145-8.

  35. Di Micoli A, Buccione D, Degli Esposti D, Santi V, Bastagli L, Borghi C, Bernardi M, et al. Terlipressin infusion induces Tako-Tsubo syndrome in a cirrhotic man with hepato-renal syndrome. Intern Emerg Med 2011; 6: 437-40.

  36. Hyun JJ, Seo YS, Lee KG, Keum B, Yim HJ, Jeen YT, Chun HJ, et al. Terlipressin-induced hyponatremic seizure. Scand J Gastroenterol 2010; 45: 501-4.

  37. Silawat FN, Shaikh MK, Lohana RK, Devrajani BR, Shah SZ, Ansari A. Efficacy of Terlipressin and Albumin in the Treatment of Hepatorenal Syndrome. WASJ 2011; 12: 1946-50.

  38. Krag A, Møller S, Henriksen JH, Holstein-Rathlou N-H, Larsen FS, Bendtsen F. Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome. Hepatology 2007; 46: 1863-71.

  39. Sagi SV, Mittal S, Kasturi KS, Sood GK. Terlipressin therapy for reversal of type 1 hepatorenal syndrome: a metaanalysis of randomized controlled trials. J Gastroenterol Hepatol 2010; 25: 880-5.

  40. Uriz J, Ginès P, Cárdenas A, Sort P, Jiménez W, Salmerón JM, Bataller R, et al. Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome. J Hepatol 2000; 33: 43-8.

  41. Epstein M. Hepatorenal syndrome: emerging perspectives of pathophysiology and therapy. J Am Soc Nephrol 1994; 4: 1735-53.

  42. Demirtas S, Can M, Yarpuzlu A. Hepatorenal syndrome. Clin Chem Lab Med 2006; 44: 379-86.




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