Octreotide/Midodrine therapy significantly improves renal function and 30-day survival in patients with type 1 hepatorenal syndrome.
Type 1 hepatorenal syndrome (HRS) can be a rapidly fatal consequence of liver failure. Recent studies have utilized vasoconstrictor therapies to combat splanchnic vasodilatation. We aimed to evaluate the efficacy of a promising treatment for type 1 HRS. We compared the survival of HRS patients who received octreotide and midodrine treatment at Rancho Los Amigos Medical Center with a concurrent untreated control group of HRS patients who did not receive this treatment. Of the 81 patients, 60 were treated with octreotide/midodrine and 21 were controls. Mortality was significantly lower in the treatment group (43%) than in the controls (71%; P < 0.05). Furthermore, 24 study patients (40%) had a sustained reduction of serum creatinine compared with only 2 controls (10%; P < 0.05). This large retrospective study suggests that octreotide/midodrine treatment appears to improve 30-day survival. A randomized, controlled trial is the next important step toward evaluating this treatment modality.
Esrailian
Eric
E
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, USA.
Pantangco
Eugene R
ER
Kyulo
Namgyal L
NL
Hu
Ke-Qin
KQ
Runyon
Bruce A
BA
D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006530:Hepatorenal Syndrome / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D015999:Multivariate Analysis; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use*; D016019:Survival Analysis; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D005765:Gastrointestinal Agents; D014662:Vasoconstrictor Agents; D008879:Midodrine; D003404:Creatinine; D015282:Octreotide