Recent advances in the management of hepato-renal syndrome (HRS)

Research output: Contribution to journalArticle

Abstract

Hepato-renal syndrome (HRS) is a functional renal failure complicating end-stage liver disease. HRS is characterized by marked arterial vasodilation (mainly of the splanchnic bed) and severe renal vasoconstriction. HRS is classified into 2 types: type IHRS shows a rapid and progressive decline in renal function with a very poor prognosis (median survival of about 2 weeks); HRS type 2 has a more stable renal failure, with a median survival of about 6 months. The management of HRS is still a big challenge. The definitive therapy for HRS is liver transplantation (LT); however, the survival rate of HRS patients is poor, and important organ shortage exists. Various approaches have been used for HRS treatment including vasoconstrictor therapy. Recent evidence has shown that vasoconstrictor agents are effective and serve as a bridge to LT; the rationale for vasoconstrictors is to counteract the splanchnic arterial vasodilation and increase the effective arterial blood volume. Thus, renal perfusion and glomerular filtration rates improve. Terlipressin, a V1 vasopressin agonist, has been used frequently. A recent meta-analysis of clinical trials showed that the pooled rate of patients who reversed HRS after terlipressin therapy was 0.52 (95% CI, 0.42; 0.61; P=0.0001, I 2=24.6%).The pooled Odds Ratio (OR) for mortality rate in HRS patients who were not responders to terlipressin versus responders was 5.746 (95% CI, 1.5; 21.9; P=0.0005). Prospective, controlled clinical trials are in progress to address the impact of vasoconstrictor use on survival in HRS patients. Alternative therapies such as transjugular intrahepatic portosystemic shunts (TIPS) and extracorporeal albumin dialysis (ECAD) have given encouraging results but experience is extremely limited.

Original languageEnglish
Pages (from-to)393-396
Number of pages4
JournalActa Clinica Belgica
Volume62
Issue numberSUPPL. 2
Publication statusPublished - 2007

Fingerprint

Kidney
Vasoconstrictor Agents
Viscera
Vasodilation
Liver Transplantation
Renal Insufficiency
Survival
Transjugular Intrahepatic Portasystemic Shunt
End Stage Liver Disease
Controlled Clinical Trials
Therapeutics
Complementary Therapies
Vasoconstriction
Blood Volume
Vasopressins
Glomerular Filtration Rate
Renal Dialysis
Meta-Analysis
Albumins
Survival Rate

Keywords

  • Hepato-renal syndrome
  • Survival
  • Terlipressin
  • Vasoconstrictor therapy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Recent advances in the management of hepato-renal syndrome (HRS). / Martin, P.; Messa, P.; Fabrizi, Fabrizi.

In: Acta Clinica Belgica, Vol. 62, No. SUPPL. 2, 2007, p. 393-396.

Research output: Contribution to journalArticle

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