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Terlipressin, a vasopressin analogue and a vasoconstrictor, has been used in Europe to treat patients with hepatorenal syndrome (HRS). The drug reverses the splanchnic vasodilation associated with cirrhosis and thus increases effective arterial volume and renal perfusion. Only a few dozen such patients have been studied in controlled trials; results from two new studies add considerably to the literature.
A randomized trial, conducted mostly in the U.S., involved 112 patients with type 1 HRS (associated with rapidly declining renal function) and a mean baseline creatinine level of 3.9 mg/dL. Patients received intravenous albumin plus terlipressin or albumin plus placebo for a maximum of 2 weeks. Treatment success (defined as serum creatinine…