Faculty Collaboration Database

Management and outcome in hepatorenal syndrome: need for renal replacement therapy in non-transplanted patients. Int Urol Nephrol 2014 Apr;46(4):793-800

Date

08/13/2013

Pubmed ID

23934619

DOI

10.1007/s11255-013-0527-7

Scopus ID

2-s2.0-84897572438 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

PURPOSE: Hepatorenal syndrome (HRS) type I is a devastating complication of decompensated cirrhosis. Liver transplantation (LT) offers an excellent survival, and renal replacement therapy (RRT) may be useful until transplantation is available. The survival benefit of RRT in the absence of LT is thought to be short and its benefit in these patients is unknown. To investigate this, we studied the outcome of different therapies (pharmacological, RRT, and LT) in patients with type 1 HRS.

METHODS: Medical records (2005-2009) of all cirrhotic patients admitted to our facility with abnormal renal function were reviewed. Patients with preexisting renal disease, diagnosis other than type I HRS, or those without long-term follow-up were excluded.

RESULTS: Of 380 patients reviewed, 30 were studied. Nineteen (63.3 %) patients underwent liver transplantation. No difference in baseline liver or renal parameters was noted between those who were or were not transplanted. A decreased mortality was noted (5.3 vs. 64.6 %; p = 0.0005) compared to patients who were not transplanted during the study follow-up median period of 7.8 [CI 1.9-34] months. Among non-transplanted patients, no differences in median survival (8.8 vs. 6.5 months; p = 0.62) or in other parameters studied were found in those patients who received RRT compared to those who did not. Similarly, no survival difference was found comparing those who did or did not receive pharmacological therapy without transplant.

CONCLUSION: In type I HRS, LT offers better survival. Among patients who do not receive LT, RRT does not provide an improved survival benefit.

Author List

Sourianarayanane A, Raina R, Garg G, McCullough AJ, O'Shea RS

Author

Achuthan Sourianarayanane MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Albumins
Female
Gastrointestinal Agents
Hepatorenal Syndrome
Humans
Liver Cirrhosis
Liver Transplantation
Male
Middle Aged
Midodrine
Octreotide
Renal Replacement Therapy
Retrospective Studies
Survival Rate
Treatment Outcome
Vasoconstrictor Agents