Role of renal replacement therapy in patients with type 1 hepatorenal syndrome receiving combination treatment of vasoconstrictor plus albumin

J Crit Care. 2015 Oct;30(5):969-74. doi: 10.1016/j.jcrc.2015.05.006. Epub 2015 May 19.

Abstract

Purpose: Utilization of renal replacement therapy (RRT) in cirrhotic patients has been controversial and is typically dependent on the status of transplantation. A better understanding of the central role for arterial vasodilatation in the pathogenesis of hepatorenal syndrome (HRS) has led to routine use of vasoconstrictors in combination with albumin as a medical therapy for HRS with prolonged patient survival. The role of RRT in HRS patients receiving such treatment, however, has not yet been examined.

Methods: A total of 80 patients with type 1 HRS who received a combination therapy of vasoconstrictors and albumin were enrolled into a retrospective cohort study. The effects of RRT status on clinical outcome were analyzed.

Results: Both short-term (30 days) and long-term (180 days) survival was similar between RRT and non-RRT groups of patients, but the length of hospital stay was significantly longer among patients in the RRT group, which remain unchanged despite adjustment of status for liver transplantation.

Conclusions: Based on our observation, routine use of RRT may not be beneficial in patients with type 1 HRS receiving combination treatment of vasoconstrictor plus albumin. Further prospective studies are needed to validate these findings and refine the specific indications for RRT in this patient population.

Keywords: Hepatorenal syndrome; Renal replacement therapy; Vasoconstrictor.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Albumins / therapeutic use*
  • Drug Therapy, Combination
  • Female
  • Hepatorenal Syndrome / drug therapy*
  • Humans
  • Length of Stay / statistics & numerical data
  • Liver Cirrhosis / therapy
  • Liver Transplantation / adverse effects
  • Male
  • Middle Aged
  • Renal Replacement Therapy / methods*
  • Retrospective Studies
  • Treatment Outcome
  • Vasoconstrictor Agents / therapeutic use*

Substances

  • Albumins
  • Vasoconstrictor Agents