MODIFIED TREATMENT OF HEPATORENAL SYNDROME TYPE I DEPENDING ON THE STAGE OF ACUTE KIDNEY INJURY

Area of Science:

• Hepatology
• Nephrology
• Pharmacology

Background:

• Hepatorenal syndrome (HRS) type I is a severe liver cirrhosis complication with poor prognosis.
• Current treatment lacks specific dosing guidelines, leading to suboptimal outcomes.
• Alcoholic liver cirrhosis is a common cause of HRS type I.

Purpose of the Study:

• To refine HRS type I treatment by adjusting terlipressin dosage based on acute kidney injury (AKI) stage.
• To improve treatment efficacy and reduce mortality in patients with alcoholic liver cirrhosis and HRS type I.

Main Methods:

• 161 patients with alcoholic liver cirrhosis and HRS type I were randomized into standard-dose and modified-dose terlipressin groups.
• AKI staging followed KDIGO criteria; terlipressin dosage was titrated based on serum creatinine response, up to 12 mg/24 hours.
• Short-term mortality risk was assessed using the MELD score.

Main Results:

• The modified terlipressin dose group showed a higher complete response rate (81.7%) compared to the standard dose group (66.7%).
• Effective terlipressin dosages were identified: 3 mg/24h for AKI stage I, 6 mg/24h for stage II, and 12 mg/24h for stage III.
• Relapse rates were lower (23.2% vs 40.1%), and short-term survival was higher (54.9% vs 37%) in the modified-dose group.

Conclusions:

• Response-guided titration of terlipressin dosage improves kidney function and clinical outcomes in HRS type I.
• Tailoring terlipressin dose to AKI stage is crucial for effective management of hepatorenal syndrome.
• This strategy reduces disease relapse and short-term mortality in patients with alcoholic liver cirrhosis.