Observation Of Vasoactive Agent In Management Of Patients With Hepatorenal Syndrome

Objective:Hepatorenal syndrome (HRS) is characterized by functional renal failure in end-stage liver disease. There is no effective medical treatment for hepatorenal syndrome. Recent studies have utilized vasoconstrictor therapies to combat splanchnic vasodilatation. Terlipressin is the one with the soundest evidence. Noradrenalin has been suggested as an effective alternative. A randomized, prospective, placebo-controlled trial should be taken to confirm the efficacy. This study aims to evaluate the effecacy and safety of vasoactive agent in management of patients with hepatorenal syndrome.Methods:Sixty-seven patients with hepatorenal syndrome were randomly divided into three groups between 2006 and 2008. Seven patients were treated with intravenous noradrenaline (0.5-3 mg/h) in group A. Thirty patients were given terlipressin 1-4 mg/day in group B and other thirty patients in group C is the control group. The epidemiology characteristics, clinical manifestation and systemic and renal parameters were monitored during treatment. Result:Group A was terminated because all the patients were dead. The other two groups were comparable at baseline. Compared with group C, the patients in group B achieved better effect. Patients in group B had a significant (P<0.05) decrease in serum creatinine from baseline (day 1 264.23±87.60μmol/L, day 3 218.85±84.81μmol/L, and day 7 188.88±135.73μmol/L). The mean arterial pressure and the total urine output were increased significantly. Nine (30%) patients in group B while only four patients (13.3%) in group C survived until day 30 (P<0.05). On Logistic regression analysis, baseline serum creatinine, was independent predictors of response to to therapy.Conclusion:Terlipressin is effective on hepatorenal syndrome with minute adverse reaction. Further study should be taken to verify the effective in treatment of patients with hepatorenal syndrome with noradrenaline.