ORIGINAL ARTICLE
Year : 2013  |  Volume : 7  |  Issue : 1  |  Page : 13-18

Norepinephrine versus terlipressin in patients with type 1 hepatorenal syndrome refractory to treatment with octreotide, midodrine, and albumin ( a prospective randomized comparative study)


Department of Anesthesia and Intensive Care, Cairo University, Cairo, Egypt

Correspondence Address:
Sahar S.I. Badawy
Department of Anesthesia and Intensive Care, Cairo University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.7123/01.EJCA.0000431078.82595.1f

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Background and objectives

Hepatorenal syndrome (HRS) is a functional renal failure complicating end-stage liver disease. Management of HRS is based on therapy with vasoconstrictors and albumin. The aim of this prospective, randomized, comparative study was to evaluate the efficacy of norepinephrine versus terlipressin in the management of patients with type 1 HRS refractory to treatment with octreotide, midodrine, and albumin.

Methods

This study included 60 patients with type 1 HRS refractory to treatment with octreotide, midodrine, and albumin for 72 h. Patients were randomized to receive norepinephrine or terlipressin plus albumin. The outcomes assessed were as follows: kidney functions, reversal of HRS, survival rate at day 30, and cost of the study medications.

Results

The final statistical analysis included 51 patients; 26 in the terlipressin group and 25 in the norepinephrine group. Demographic data and baseline patient characteristics were comparable in the two groups. The incidences of HRS reversal were comparable in the two groups. In both groups, there was an improvement in kidney functions. The responders in both groups showed a significant improvement in kidney functions at the end of the study compared with baseline. There was a significant progressive decrease in serum creatinine (P⩽0.05) levels and a significant progressive increase in creatinine clearance (P⩽0.05) and urine output (P⩽0.05) compared with baseline. Both groups were comparable throughout the study. The survival rates at day 30 were comparable in the two groups. The cost of norepinephrine therapy was significantly lower than that of terlipressin therapy (57 560±16 870 vs. 13 492±7694 Egyptian pounds; P⩽0.05).

Conclusion

The results of this study suggested that norepinephrine is as effective as terlipressin in the management of patients with type 1 HRS.



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