Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome

Background/Aim: Ornipressin, a vasopressin analog with potent splanchnic vasoconstrictor action, has been shown to reverse hepatorenal syndrome. However, its usefulness in clinical practice is limited by frequent ischemic complications. The aim of this study was to assess the efficacy of terlipressin, an analog of vasopressin with a low profile of side effects, plus albumin in this condition. Methods: Nine consecutive patients with cirrhosis and hepatorenal syndrome were included in a pilot study of terlipressin (0.5–2 mg/4 h iv) therapy associated with iv albumin. Results: Treatment (9 days, range 5–15) was associated with a marked reduction of serum creatinine (3.9±0.7 to 1.3±0.1 mg/dl, p<0;0.001, mean±SE). Reversal of hepatorenal syndrome (reduction of creatinine below 1.5 mg/dl) was observed in seven of the nine patients. There was a remarkable improvement in circulatory function, with an increase in mean arterial pressure (68±2 to 80±4 mmHg, p<0;0.05) and suppression of vasoconstrictor systems activity (plasma renin activity and plasma norepinephrine decreased from 23±12 ng/ml • h and 1549±373 pg/ml to 3.5±2 ng/ml • h and 373±98 pg/ml, respectively, p<0;0.01 for both). No patient developed signs of intestinal, myocardial or distal ischemia. Conclusions: Terlipressin associated with albumin appears to be a safe and effective treatment of hepatorenal syndrome.