The use of vasoconstrictors in patients with cirrhosis: Type 1 HRS and beyond
- 1 March 2006
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Hepatology
- Vol. 43 (3), 385-394
- https://doi.org/10.1002/hep.21094
Abstract
In patients with cirrhosis and type 1 hepatorenal syndrome (HRS), systemic vasodilation, which is mainly attributable to splanchnic vasodilation, plays a critical role in the activation of endogenous vasoconstrictor systems, resulting in renal vasoconstriction and functional renal failure. It has been suggested that the use of splanchnic (and systemic) vasoconstrictors such as terlipressin (a vasopressin analog) or alpha‐1‐adrenoceptor agonists (midodrine or noradrenaline) may improve renal function in patients with type 1 HRS. Six studies (with only one randomized study in a small series of patients) have shown that terlipressin improves renal function in these patients. However, there is evidence that terlipressin alone may be less effective than terlipressin combined with intravenous albumin in improving renal function. Future randomized studies should confirm this difference and evaluate the impact of terlipressin therapy (with or without intravenous albumin) on survival. Interestingly, in nonrandomized studies, the use of alpha‐1 agonists combined with other therapies (octreotide and albumin for midodrine; furosemide and albumin for noradrenaline) has been shown to improve renal function in patients with type 1 HRS. The efficacy and safety of combined therapies including alpha‐1 agonists should be confirmed in randomized studies. Finally, preliminary evidence suggests that vasoconstrictor administration may be a novel therapeutic approach targeting vasodilation involved in the mechanism of: (1) renal failure in type 2 HRS; (2) paracentesis‐induced circulatory dysfunction; and (3) arterial hypotension induced by byproducts of gram‐negative bacteria. Further studies are needed in all these fields. (HEPATOLOGY 2006;43:385–394.)Keywords
This publication has 48 references indexed in Scilit:
- Circulatory function and hepatorenal syndrome in cirrhosisHepatology, 2005
- Evolving Consensus in Portal Hypertension Report of the Baveno IV Consensus Workshop on methodology of diagnosis and therapy in portal hypertensionJournal of Hepatology, 2005
- Pharmacological treatment of hepatorenal syndromeAlimentary Pharmacology & Therapeutics, 2004
- Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndromeHepatology, 2004
- Terlipressin inhibitsin vivoaortic iNOS expression induced by lipopolysaccharide in rats with biliary cirrhosisHepatology, 2002
- Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: Results of a prospective, nonrandomized studyHepatology, 2002
- Beneficial effects of the 2-day administration of terlipressin in patients with cirrhosis and hepatorenal syndromeJournal of Hepatology, 1998
- Acute effects of the oral administration of midodrine, an ?-adrenergic agonist, on renal hemodynamics and renal function in cirrhotic patients with ascitesHepatology, 1998
- Reversibility of hepatorenal syndrome by prolonged administration of ornipressin and plasma volume expansionHepatology, 1998
- Endogenous factors involved in the control of arterial tone in cirrhosisJournal of Hepatology, 1995