Is terlipressin plus albumin or midodrine and octreotide plus albumin effective in the treatment of hepatorenal syndrome (HRS)?

Updated: Oct 16, 2017
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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Answer

In a randomized controlled trial that compared the effectiveness of terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of HRS in 27 patients, Cavallin and colleagues found a significantly higher rate of improvement in renal function with telipressin plus albumin compared to midodrine/octreotide plus albumin. [38]

Angeli et al showed that long-term administration of midodrine (an alpha-adrenergic agonist) and octreotide improved renal function in 8 patients with type 1 HRS. [39] All patients also received albumin, and this approach was compared to dopamine at nonpressor doses. Not surprisingly, none of the patients treated with dopamine showed any improvement in renal function, but all 8 patients treated with midodrine, octreotide, and volume expansion had improvement in renal function. No adverse effects were reported in these patients. A study of 14 patients by Wong et al reported improvement in renal function in 10 patients. Three of these patients subsequently underwent liver transplantation. [40]


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