Renal and neurohormonal changes following simultaneous administration of systemic vasoconstrictors and dopamine or prostacyclin in cirrhotic patients with hepatorenal syndrome.
OBJECTIVE
Intravenous ornipressin in cirrhotic patients with hepatorenal syndrome causes marked improvement of systemic hemodynamics and suppression of plasma renin and norepinephrine but only moderate improvement of renal function. This study was designed to investigate whether these beneficial effects could be enhanced by the simultaneous administration of dopamine. The renal effects of the i.v. infusion of norepinephrine plus prostacyclin in patients with hepatorenal syndrome were also assessed.


METHODS
Renal plasma flow, glomerular filtration rate, free water clearance, sodium excretion and the plasma levels of renin and norepinephrine were measured in baseline conditions and during the administration of ornipressin (6 i.u./h) and ornipressin (6 i.u./h) plus dopamine (2 micrograms/kg.min) in nine patients with hepatorenal syndrome. Five additional patients with hepatorenal syndrome were studied prior to and following the administration of norepinephrine (0.45 +/- 0.1 microgram/kg.min) and norepinephrine (0.85 +/- 0.2 microgram/kg.min) plus prostacyclin (5 ng/kg.min).


RESULTS
Despite a significant increase in arterial pressure and marked suppression of plasma renin activity during ornipressin and ornipressin plus dopamine administration, no significant improvement in renal function was observed. Norepinephrine and norepinephrine plus prostacyclin also failed to increase renal perfusion and glomerular filtration rate.


CONCLUSIONS
The combined administration of systemic vasoconstrictors (ornipressin or norepinephrine) and vasodilators (dopamine or prostacyclin), at the doses used in the current study and for a short period of time, does not improve renal function in cirrhotic patients with hepatorenal syndrome. The current study does not confirm a potential role for ornipressin in the treatment of hepatorenal syndrome.
Saló
J
J
Department of Medicine, Hospital Clínic i Provincial, Barcelona, Spain.
Ginès
A
A
Quer
J C
JC
Fernández-Esparrach
G
G
Guevara
M
M
Ginès
P
P
Bataller
R
R
Planas
R
R
Jiménez
W
W
Arroyo
V
V
Rodés
J
J
D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D004298:Dopamine / Q000008:administration & dosage* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D011464:Epoprostenol / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006530:Hepatorenal Syndrome / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects / Q000502:physiology*; D008103:Liver Cirrhosis / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage / Q000097:blood*; D009951:Ornipressin / Q000008:administration & dosage* / Q000627:therapeutic use; D017595:Renal Plasma Flow / Q000187:drug effects; D012083:Renin / Q000097:blood; D012964:Sodium / Q000652:urine; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use
D000959:Antihypertensive Agents; D014662:Vasoconstrictor Agents; D009951:Ornipressin; D012964:Sodium; D011464:Epoprostenol; D012083:Renin; D004298:Dopamine; D009638:Norepinephrine