Octreotide/Midodrine Therapy Significantly Improves Renal Function and 30-Day Survival in Patients with Type 1 Hepatorenal Syndrome
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Type 1 hepatorenal syndrome (HRS) can be a rapidly fatal consequence of liver failure. Recent studies have utilized vasoconstrictor therapies to combat splanchnic vasodilatation. We aimed to evaluate the efficacy of a promising treatment for type 1 HRS. We compared the survival of HRS patients who received octreotide and midodrine treatment at Rancho Los Amigos Medical Center with a concurrent untreated control group of HRS patients who did not receive this treatment. Of the 81 patients, 60 were treated with octreotide/midodrine and 21 were controls. Mortality was significantly lower in the treatment group (43%) than in the controls (71%; P < 0.05). Furthermore, 24 study patients (40%) had a sustained reduction of serum creatinine compared with only 2 controls (10%; P < 0.05). This large retrospective study suggests that octreotide/midodrine treatment appears to improve 30-day survival. A randomized, controlled trial is the next important step toward evaluating this treatment modality.
KeywordsCirrhosis Renal failure Hepatorenal syndrome Ascites Portal hypertension
This paper is dedicated to Dr. Telfer B. Reynolds, who spent his distinguished career studying, teaching about, and caring for patients with liver failure and fluid and electrolyte imbalance. His influence on the authors and on this study cannot be quantified.
- 1.v. Frerichs T (1877) Tratado práctico de las enfermedades del hígado, de los vasos hepáticos y de las vias biliares. Librería Extranjera y Nacional, científica y Literaria, Madrid, pp 362–353Google Scholar
- 3.Hecker R, Sherlock S (1956) Electrolyte and circulatory changes in terminal liver failure. Lancet 2:1221–1225Google Scholar
- 12.Ortega R, Ginés P, Uriz J, Cardenas A, Calahorra B, De Las Heras D, Guevara M, Bataller R, Jimenez W, Arroyo V, Rodes J (2002) Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology 36:941–948PubMedGoogle Scholar
- 13.Moreau R, Durand F, Poynard T, Duhamel C, Cervoni JP, Ichai P, Abergel A, Halimi C, Pauwels M, Bronowicki JP, Giostra E, Fleurot C, Gurnot D, Nouel O, Renard P, Rivoal M, Blanc P, Coumaros D, Ducloux S, Levy S, Pariente A, Perarnau JM, Roche J, Scribe-Outtas M, Valla D, Bernard B, Samuel D, Butel J, Hadengue A, Platek A, Lebrec D, Cadranel JF (2002) Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology 122:923–930PubMedCrossRefGoogle Scholar
- 18.Cárdenas A, Ginés P, Rodés J (2003) Renal complications. In: Schiff ER, Sorrell MF, Maddrey WC (eds) Schiff's diseases of the liver. 9th ed. Lippincott Williams & Wilkins, Philadelphia, pp 497–509Google Scholar
- 24.Papper S (1983) The hepatorenal syndrome. In: Epstein M (ed) The kidney in liver disease. 2nd ed. Elsevier Biomedical, New York, pp 87–106Google Scholar