Effects of noradrenalin and albumin in patients with type I hepatorenal syndrome: a pilot study.
Treatment of hepatorenal syndromes (HRSs) is currently based on vasopressin analogs. The aim of this pilot study was to evaluate the efficacy and safety of noradrenalin (NA) in the treatment of type 1 HRS. Between 1998 and 2000, 12 consecutive patients with type 1 HRS (7 men, 5 women; mean age, 54 +/- 11 years; mean Child-Pugh score, 11.3 +/- 1.7) were treated with intravenous NA (0.5-3 mg/h), in combination with intravenous albumin and furosemide. NA was given for 10 +/- 3 days, at a mean dose of 0.8 +/- 0.3 mg/h. Reversal of HRS was observed in 10 of 12 patients (83%; 95% confidence interval, 52%-98%) after a median of 7 days (range, 5-10 days). Serum creatinine levels fell from 358 +/- 161 to 145 +/- 78 micromol/L (P <.001), creatinine clearance rose from 13 +/- 9 to 40 +/- 15 mL/min (P =.003), and urinary sodium output increased from 8 +/- 14 to 52 +/- 72 mEq/d (P =.002). Changes in renal function under NA treatment were associated with an increase in mean arterial pressure (MAP; 65 +/- 7 to 73 +/- 9 mm Hg, P =.01) and a marked reduction in active renin (565 +/- 989 to 164 +/- 196 ng/L, P =.001) and aldosterone plasma concentrations (1,945 +/- 1,931 to 924 +/- 730 ng/mL, P =.02). There was one episode of reversible myocardial hypokinesia (in a patient on 1.5 mg/h NA) that did not recur after a dose reduction. In conclusion, NA combined with albumin and furosemide appears effective and safe for the treatment of type 1 HRS.
Duvoux
Christophe
C
Service d'Hépatologie et de Gastroentérologie, AP-HP, Hopital Henri Mondor, Créteil, France. cduvoux@easynet.fr
Zanditenas
David
D
Hézode
Christophe
C
Chauvat
Anthony
A
Monin
Jean-Luc
JL
Roudot-Thoraval
Françoise
F
Mallat
Ariane
A
Dhumeaux
Daniel
D
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000418:Albumins / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects; D006530:Hepatorenal Syndrome / Q000188:drug therapy*; D006801:Humans; D007275:Injections, Intravenous; D008103:Liver Cirrhosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage* / Q000009:adverse effects; D010865:Pilot Projects; D011446:Prospective Studies; D012084:Renin-Angiotensin System / Q000187:drug effects; D014661:Vasoconstriction / Q000187:drug effects
D000316:Adrenergic alpha-Agonists; D000418:Albumins; D009638:Norepinephrine