title: Which patients benefit from hemodialysis therapy in hepatorenal syndrome?
abstract: OBJECTIVE
  Hepatorenal syndrome (HRS) occurs in patients with advanced liver cirrhosis and has a poor outcome. The aim of the present study was to investigate which patients with HRS are likely to benefit from hemodialysis.
  
  
  METHODS
  Data were collected prospectively from 30 patients with Child-Pugh C liver cirrhosis and HRS. Patients were either treated with continuous veno-venous hemodialysis (CVVHD) if they were mechanically ventilated, or with intermittent hemodialysis (HD) if they were not mechanically ventilated. Prognosis was assessed by the Child-Pugh and by the Model for End-Stage Liver Disease (MELD) score. The primary aim of the study was the analysis of overall and 30-day patient survival during hemodialysis therapy. To identify predictive factors of survival, variables obtained before the initiation of dialysis therapy were evaluated.
  
  
  RESULTS
  Patients' 30-day survival was 8/30 (median survival time 21 days). Among patients treated with mechanical ventilation, 30-day survival time was 0/15 while 8/15 patients without mechanical ventilation survived more than 30 days (P < 0.001). Using a multivariate model, the relative hazards for serum albumin, international normalized ratio (INR) and catecholamine therapy were not different from one another (P > 0.05), indicating that these parameters were not independent predictors of survival. Mechanical ventilation was an independent risk factor for 30-day (relative hazard 6.6 [1.6-27.7], P < 0.001) and overall survival (relative hazard 6.3 [1.5-26.5], P = 0.01). Child-Pugh (P < 0.01) and the MELD (P < 0.01) score were predictive for overall survival independent of mechanical ventilation.
  
  
  CONCLUSIONS
  Patients with HRS without mechanical ventilation may benefit from hemodialysis, whereas hemodialysis seems to be futile in patients with mechanical ventilation.
authors.affiliation: Department of Nephrology, University Clinic Essen, Essen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Witzke
authors.forename: Markus
authors.initials: M
authors.lastname: Baumann
authors.forename: Daniel
authors.initials: D
authors.lastname: Patschan
authors.forename: Susann
authors.initials: S
authors.lastname: Patschan
authors.forename: Anna
authors.initials: A
authors.lastname: Mitchell
authors.forename: Ulrich
authors.initials: U
authors.lastname: Treichel
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Thomas
authors.initials: T
authors.lastname: Philipp
authors.forename: Andreas
authors.initials: A
authors.lastname: Kribben
mesh_terms: D000328:Adult; D005260:Female; D006530:Hepatorenal Syndrome / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D015996:Survival Rate; D013997:Time Factors