Abeer Ahmed

Citation:

Badawy, S. S. I., N. M. Meckawy, and A. Ahmed, "Norepinephrine versus terlipressin in patients with type 1 hepatorenal syndrome refractory to treatment with octreotide, midodrine, and albumin: a prospective randomized comparative study", The Egyptian Journal of Cardiothoracic Anesthesia , vol. 7, pp. 13-18, 2013.

Abstract:

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 (Pr0.05) levels and a significant progressive increase in
creatinine clearance (Pr0.05) and urine output (Pr0.05) 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; Pr0.05).
Conclusion
The results of this study suggested that norepinephrine is as effective as terlipressin in
the management of patients with type 1 HRS.