title: Octreotide/Midodrine therapy significantly improves renal function and 30-day survival in patients with type 1 hepatorenal syndrome.
abstract: 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.
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at UCLA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Esrailian
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Pantangco
authors.forename: Namgyal L
authors.initials: NL
authors.lastname: Kyulo
authors.forename: Ke-Qin
authors.initials: KQ
authors.lastname: Hu
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Runyon
mesh_terms: 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*
chemical_list: D005765:Gastrointestinal Agents; D014662:Vasoconstrictor Agents; D008879:Midodrine; D003404:Creatinine; D015282:Octreotide