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Terlipressin/albumin improves renal function in patients with hepatorenal syndrome

Patients with hepatorenal syndrome, or HRS, treated with a regimen of terlipressin/albumin had higher rates of improved renal function vs. patients treated with a regimen of midodrine and octreotide/albumin, according to newly published data in Hepatology.

“The combination of midodrine and octreotide has not been compared with terlipressin in the treatment of HRS,” the researchers wrote. “Therefore, the aim of this study was to compare terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of HRS in patients with cirrhosis.”

Researchers randomly assigned 49 patients with HRS to a terlipressin/albumin (n = 27) or midodrine and octreotide/albumin (n = 22) treatment regimen. Patients in the terlipressin group received 3 mg per day to start, then received an increased dose of 12 mg per day if there was no response to the 3 mg. Patients in the midodrine group received 7.5 mg midodrine three times per day, which increased to a maximum of 12.5 mg three times a day with octreotide subcutaneously, according to the research.

Overall, patients in both treatment groups showed improved renal function after treatment. However, more patients in the terlipressin group showed partial or complete improved renal function compared with patients in the midodrine/octreotide group (19/27 vs. 6/21). Of the patients with improved renal function in both groups, 15 of 27 patients in the terlipressin group had a complete response compared with one of 21 patients in the midodrine/octreotide group (P < .001).

“Improvement in renal function was associated with a significant increase in arterial pressure in both groups, confirming the existence of a major relationship between circulatory and renal function in patients with HRS,” the researchers wrote.

Response to treatment and baseline model for end-stage liver disease score were predictors of 3-month survival, according to multivariate analysis. In univariate analysis, response was the only predictor of 3-month survival among the patients.

Adverse events were minimal among the patients, with one patient in the terlipressin group and one in the midodrine/octreotide group discontinuing treatment as a result.

“The results of this randomized, comparative study indicate that administration of terlipressin plus albumin is more effective in improving both renal function and survival in patients with cirrhosis and HRS compared with midodrine and octreotide plus albumin,” the researchers concluded. “Thus, terlipressin plus albumin should currently be considered the first choice for management of patients with cirrhosis and HRS.”

Disclosure: The researchers report no relevant financial disclosures.