The liver and kidney in critically ill patients

Both liver and kidney dysfunction are associated with adverse outcomes in critical illness. Advanced liver disease can be complicated by the hepatorenal syndrome (HRS) with liver transplantation offering the best long-term outcome. However, until recently, HRS was associated with such a poor prognosis that this group of patients rarely survived long enough for transplantation to be considered. The use of vasopressin analogues and albumin infusions has improved the management of HRS and outcomes in terms of renal recovery and survival.