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NDT Advance Access published online on June 14, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh930
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received January 24, 2005
Accepted May 3, 2005

Original Articles

Vasopressin, not octreotide, may be beneficial in the treatment of hepatorenal syndrome: a retrospective study

Tyree H. Kiser 1, Douglas N. Fish 1, Marilee D. Obritsch 1, Rose Jung 1, Robert MacLaren 1, and Chirag R. Parikh 2*

1 Department of Clinical Pharmacy, School of Pharmacy, University of Colorado Health Sciences Center, Denver, CO, USA
2 Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA

* To whom correspondence should be addressed.
Chirag R. Parikh, E-mail: chirag.parikh{at}yale.edu



  Abstract

Background. Hepatorenal syndrome (HRS) is a severe complication of cirrhosis and is associated with high mortality. Ornipressin and terlipressin are effective in treatment of HRS, but are not available in the USA. The efficacy of vasopressin (AVP) and octreotide (OCT) infusions, commonly utilized in the USA, in the treatment of HRS is unknown. This study aims to evaluate the effects of AVP and OCT on renal function, systemic haemodynamics and clinical outcomes in HRS.

Methods. This observational study evaluated patients receiving AVP or OCT therapy for HRS from January 2000 to December 2003. Recovery from HRS was defined as a decrease in the serum creatinine (SCr) to a value ≤1.5 mg/dl.

Results. Forty-three patients were identified: eight received AVP, 16 received OCT and 19 received both AVP and OCT. Patients who received AVP alone or in combination with OCT had significantly greater recovery rates than those receiving OCT monotherapy (42 vs 38 vs 0%, respectively, P = 0.01). The average time to response in serum creatinine (SCr) was 7± 2 days. The mean AVP doses were 0.23±0.19 U/min in patients demonstrating clinical response. Therapy with AVP was an independent predictor of recovery (odds ratio 6.4, 95% confidence interval 1.3-31.8). Patients who responded to therapy had significantly lower mortality (23 vs 67%, P = 0.008) and higher rates of liver transplantation (23 vs 0%, P = 0.005). No adverse effects related to AVP therapy were observed.

Conclusion. When compared with OCT, HRS patients treated with AVP had significantly higher recovery rates, improved survival and were more likely to receive a liver transplant.

Keywords: acute renal failure; cirrhosis; dopamine; mortality; recovery; response.
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