Vasopressin, not octreotide, may be beneficial in the treatment of hepatorenal syndrome: a retrospective study.
BACKGROUND
Hepatorenal syndrome (HRS) is a severe complication of cirrhosis and is associated with high mortality. Ornipressin and terlipressin are effective in treatment of HRS, but are not available in the USA. The efficacy of vasopressin (AVP) and octreotide (OCT) infusions, commonly utilized in the USA, in the treatment of HRS is unknown. This study aims to evaluate the effects of AVP and OCT on renal function, systemic haemodynamics and clinical outcomes in HRS.


METHODS
This observational study evaluated patients receiving AVP or OCT therapy for HRS from January 2000 to December 2003. Recovery from HRS was defined as a decrease in the serum creatinine (SCr) to a value < or =1.5 mg/dl.


RESULTS
Forty-three patients were identified: eight received AVP, 16 received OCT and 19 received both AVP and OCT. Patients who received AVP alone or in combination with OCT had significantly greater recovery rates than those receiving OCT monotherapy (42 vs 38 vs 0%, respectively, P = 0.01). The average time to response in serum creatinine (SCr) was 7+/- 2 days. The mean AVP doses were 0.23+/-0.19 U/min in patients demonstrating clinical response. Therapy with AVP was an independent predictor of recovery (odds ratio 6.4, 95% confidence interval 1.3-31.8). Patients who responded to therapy had significantly lower mortality (23 vs 67%, P = 0.008) and higher rates of liver transplantation (23 vs 0%, P = 0.005). No adverse effects related to AVP therapy were observed.


CONCLUSIONS
When compared with OCT, HRS patients treated with AVP had significantly higher recovery rates, improved survival and were more likely to receive a liver transplant.
Kiser
Tyree H
TH
Department of Clinical Pharmacy, School of Pharmacy, University of Colorado Health Sciences Center, Denver, CO, USA.
Fish
Douglas N
DN
Obritsch
Marilee D
MD
Jung
Rose
R
MacLaren
Robert
R
Parikh
Chirag R
CR
D050034:Antidiuretic Agents / Q000627:therapeutic use; D001127:Arginine Vasopressin / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006530:Hepatorenal Syndrome / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D012189:Retrospective Studies
D050034:Antidiuretic Agents; D001127:Arginine Vasopressin; D015282:Octreotide