Terlipressin therapy for renal failure in cirrhosis.

Abstract

OBJECTIVES:

Renal failure is common in cirrhosis frequently due to hepatorenal syndrome (HRS). Terlipressin and albumin improve renal function with a trend to prolong survival in HRS, but prognostic factors with therapy have been poorly studied.

METHODS:

Forty-five cirrhotics seen consecutively in a single centre with renal failure defined as oliguria/anuria and/or rising creatinine and no response to volume loading, without intrinsic renal disease, sepsis, gastrointestinal bleeding [median Child-Pugh score 12(8-14)/Model for End-Stage Liver Disease 29(10-40)], had intravenous terlipressin and albumin and were audited retrospectively classified into three groups: group 1 HRS type 1 (15), group 2 HRS type 2 (11) and group 3(19): not fulfilling HRS 1 or 2 criteria. Baseline median creatinine was 1.7 (0.9-5.46) mg/dl and 30 (67%) had creatinine greater than 1.5 mg/dl. All 45 patients had initial colloid/albumin and 31 continued terlipressin (2-4 mg/day) for a median 8 (2-76) days.

RESULTS:

Improvement in serum creatinine occurred in 23 (51%) [(1.3 mg/dl (0.6-3.9)] compared with baseline [1.7 mg/dl (0.92-3.75)] (P<0.001). In the multivariate analysis a greater reduction in creatinine between baseline and day 4 (95% confidence interval, odds ratio: 0.25) was associated with improved survival at 6 weeks.

CONCLUSION:

Albumin and terlipressin improve renal failure in the absence of sepsis in cirrhosis independently of whether HRS criteria are fulfilled or not. Improvement at 4 days of therapy is associated with better survival. Randomized studies are needed for oliguria and rising creatinine in cirrhotics even if HRS criteria are not fulfilled.

• Authors: Christos K Triantos, Dimitrios Samonakis, Ulrich Thalheimer, Evangelos Cholongitas, Marco Senzolo, Laura Marelli, Gioacchino Leandro, David Patch, Andrew K Burroughs
• Journal: European journal of gastroenterology & hepatology (Eur J Gastroenterol Hepatol) Vol. 22 Issue 4 Pg. 481-6 (Apr 2010) ISSN: 1473-5687 [Electronic] England
• PMID: 19952764 (Publication Type: Journal Article)

Chemical References

• Electrolytes
• Serum Albumin
• Vasoconstrictor Agents
• Lypressin
• Terlipressin
• Urea
• Creatinine

Topics

• Adult
• Aged
• Creatinine (blood)
• Electrolytes (blood, urine)
• Female
• Hemodynamics (drug effects)
• Hepatorenal Syndrome (complications, drug therapy)
• Humans
• Liver Cirrhosis (complications)
• Lypressin (analogs & derivatives, therapeutic use)
• Male
• Middle Aged
• Multivariate Analysis
• Renal Insufficiency (complications, drug therapy, mortality)
• Retrospective Studies
• Serum Albumin (physiology)
• Terlipressin
• Treatment Outcome
• Urea (blood, urine)
• Vasoconstrictor Agents (therapeutic use)
• Young Adult