These results support consideration for a goal-directed approach to the treatment of HRS.Ĭopyright © 2011 National Kidney Foundation, Inc. We lacked access to individual patient data.Īn increase in MAP during vasoconstrictor therapy in patients with HRS is associated with improvement in kidney function across the spectrum of drugs tested to date. Studies were not originally designed to test our question. Furthermore, a decrease in PRA correlated with improvement in kidney function. Excluding cohorts of participants treated with terlipressin or ornipressin did not eliminate the association. Most studies tested terlipressin as vasoconstrictor, whereas fewer studies tested ornipressin, midodrine, octreotide, or norepinephrine. Associations were stronger when analyses were restricted to randomized clinical trials and were not limited to cohorts with either lower baseline MAP or lower baseline serum creatinine level. Correlations were used to assess for association between variables.Īn increase in MAP is associated strongly with a decrease in serum creatinine level, but is not associated with an increase in urinary output. Linear regression models were constructed to estimate mean daily changes in MAP, serum creatinine level, urinary output, and PRA for each study subgroup. Human studies evaluating the efficacy of a vasoconstrictor administered for 72 hours or longer in adults with HRS type 1 or 2.Ĭohorts' mean arterial pressure (MAP), serum creatinine level, urinary output, and plasma renin activity (PRA) at baseline and subsequent times during treatment. Pooled analysis of published studies identified by electronic database search.ĭata pooled across 501 participants in 21 studies. Our aim was to explore across all tested vasoconstrictors whether achievement of a substantial increase in arterial blood pressure is associated with recovery of kidney function in HRS. Vasoconstrictor therapy has been advocated as treatment for hepatorenal syndrome (HRS).
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