title: Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: A randomized trial.
abstract: Hepatorenal syndrome (HRS), a serious complication of cirrhosis, is associated with high mortality without treatment. Terlipressin with albumin is effective in the reversal of HRS. Where terlipressin is not available, as in the United States, midodrine and octreotide with albumin are used as an alternative treatment of HRS. The aim was to compare the effectiveness of terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of HRS in a randomized controlled trial. Twenty-seven patients were randomized to receive terlipressin with albumin (TERLI group) and 22 to receive midodrine and octreotide plus albumin (MID/OCT group). The TERLI group received terlipressin by intravenous infusion, initially 3 mg/24 hours, progressively increased to 12 mg/24 hours if there was no response. The MID/OCT group received midodrine orally at an initial dose of 7.5 mg thrice daily, with the dose increased to a maximum of 12.5 mg thrice daily, together with octreotide subcutaneously: initial dose 100 μg thrice daily and up to 200 μg thrice daily. Both groups received albumin intravenously 1 g/kg of body weight on day 1 and 20-40 g/day thereafter. There was a significantly higher rate of recovery of renal function in the TERLI group (19/27, 70.4%) compared to the MID/OCT group (6/21, 28.6%), P = 0.01. Improvement in renal function and lower baseline Model for End-Stage Liver Disease score were associated with better survival.
  
  
  CONCLUSIONS
  Terlipressin plus albumin is significantly more effective than midodrine and octreotide plus albumin in improving renal function in patients with HRS.
authors: Department of Medicine, DIMED, Padua, Italy.
authors: Marta
authors: M
authors: Cavallin
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, College of Medicine, Rochester, MN.
authors: Patrick S
authors: PS
authors: Kamath
authors: Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
authors: Manuela
authors: M
authors: Merli
authors: Department of Medicine, DIMED, Padua, Italy.
authors: Silvano
authors: S
authors: Fasolato
authors: Internal Medicine, University of Udine, Udine, Italy.
authors: Pierluigi
authors: P
authors: Toniutto
authors: IRCCS Hospital, University of Milan, Milan, Italy.
authors: Francesco
authors: F
authors: Salerno
authors: Department of Clinical Medicine, University of Bologna, Bologna, Italy.
authors: Mauro
authors: M
authors: Bernardi
authors: Internal Medicine, University of Florence, Florence, Italy.
authors: Roberto Giulio
authors: RG
authors: Romanelli
authors: General Hospital of Omegna (Verbania), Verbania, Italy.
authors: Cosimo
authors: C
authors: Colletta
authors: Hospital Giovanni XXIII of Monastier di Treviso, Treviso, Italy.
authors: Freddy
authors: F
authors: Salinas
authors: General Hospital of Comiso (Ragusa), Ragusa, Italy.
authors: Antonio
authors: A
authors: Di Giacomo
authors: Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
authors: Lorenzo
authors: L
authors: Ridola
authors: Internal Medicine, University of Udine, Udine, Italy.
authors: Ezio
authors: E
authors: Fornasiere
authors: Department of Clinical Medicine, University of Bologna, Bologna, Italy.
authors: Paolo
authors: P
authors: Caraceni
authors: Department of Medicine, DIMED, Padua, Italy.
authors: Filippo
authors: F
authors: Morando
authors: Department of Medicine, DIMED, Padua, Italy.
authors: Salvatore
authors: S
authors: Piano
authors: Department of Medicine, DIMED, Padua, Italy.
authors: Angelo
authors: A
authors: Gatta
authors: Department of Medicine, DIMED, Padua, Italy.|Unit of Hepatic Emergencies and Liver Transplantation, University of Padua, Padua, Italy.
authors: Paolo
authors: P
authors: Angeli
mesh_terms: D000368:Aged; D000418:Albumins / Q000008:administration & dosage*; D000704:Analysis of Variance; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000008:administration & dosage*; D015282:Octreotide / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D016019:Survival Analysis; D000077585:Terlipressin; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D008236:Lypressin; D008879:Midodrine; D000077585:Terlipressin; D015282:Octreotide