Treatment of hepatorenal syndrome as defined by the international ascites club by albumin and furosemide infusion according to the central venous pressure: a prospective pilot study.
OBJECTIVE
Hepatorenal syndrome (HRS) is a functional renal failure that occurs late during cirrhosis. The prognosis is extremely poor with a mean survival of 1.7 wks from the time of diagnosis. The aim of the present study was to examine the effects of albumin and furosemide administration tailored to central venous pressure (CVP) on renal function and clinical outcome.


METHODS
We treated 20 consecutive patients with HRS. Albumin was given to increase and/or maintain CVP above 3 cm H(2)O. If diuresis remained below 50 mL/h despite effective volume expansion, furosemide was administrated. Patients were considered responders and treatment was discontinued when creatinine clearance rose above 40 mL/min or serum creatinine fell under 132 mumol/L.


RESULTS
The need for albumin varied from patient to patient (extremes 40-600 g) and in the same patient from day to day. All but one needed furosemide. Eleven patients (55%) responded to treatment. In this population, diuresis, serum creatinine, and creatinine clearance were all significantly improved. Creatinine clearance at baseline was predictive of treatment efficacy. Survival increased in these patients compared to nonresponders defined as patients with no improvement in renal function (259 days +/- 113 compared to 14 days +/- 3, p < 0.0005). Response to treatment and the type of HRS were the only variables with an independent prognostic value.


CONCLUSIONS
This study shows that HRS as defined by the International Ascites Club can be treated by albumin administration alone or with furosemide given according to the patient's specific need using CVP.
Péron
Jean-Marie
JM
Service d'Hépato-Gastro-Entérologie, Fédération Digestive, Hôpital Purpan, Toulouse, France.
Bureau
Christophe
C
Gonzalez
Laurent
L
Garcia-Ricard
Franck
F
de Soyres
Olivier
O
Dupuis
Emmanuel
E
Alric
Laurent
L
Pourrat
Jacques
J
Vinel
Jean-Pierre
JP
D000328:Adult; D000418:Albumins / Q000627:therapeutic use*; D000704:Analysis of Variance; D002496:Central Venous Pressure / Q000187:drug effects* / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005665:Furosemide / Q000627:therapeutic use*; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007262:Infusions, Intravenous; D007391:International Cooperation; D007677:Kidney Function Tests; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D015999:Multivariate Analysis; D010865:Pilot Projects; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012955:Societies, Medical; D015996:Survival Rate; D016896:Treatment Outcome
D000418:Albumins; D005665:Furosemide