Do Medications for Hepatorenal Syndrome Work?

In a meta-analysis, vasoactive regimens conferred no mortality benefit and didn't prevent serious adverse events.

For cirrhotic patients with hepatorenal syndrome (HRS), guidelines continue to recommend splanchnic vasoconstrictor medications (e.g., midodrine, octreotide, vasopressin) in combination with albumin, despite conflicting evidence about efficacy (Hepatology 2013; 57:1651). In a network meta-analysis of 25 randomized controlled trials with >1200 patients with HRS (type I, type II, or both), investigators compared the effect of albumin plus various vasoactive medications: noradrenaline; terlipressin; octreotide; midodrine plus octreotide; and midodrine plus octreotide plus pentoxifylline. Vasoactive medications were compared with each other and with albumin alone. Follow-up varied from 1 week to 6 months.

Overall, mortality was high (59%), and r…

Reviewing Authors

John P. Haydek, MD

Daniel D. Dressler, MD, MSc, SFHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Daniel D. Dressler, MD, MSc, SFHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Do Medications for Hepatorenal Syndrome Work?

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Reviewing Authors