title: Role of renal replacement therapy in patients with type 1 hepatorenal syndrome receiving combination treatment of vasoconstrictor plus albumin.
abstract: OBJECTIVE
  Utilization of renal replacement therapy (RRT) in cirrhotic patients has been controversial and is typically dependent on the status of transplantation. A better understanding of the central role for arterial vasodilatation in the pathogenesis of hepatorenal syndrome (HRS) has led to routine use of vasoconstrictors in combination with albumin as a medical therapy for HRS with prolonged patient survival. The role of RRT in HRS patients receiving such treatment, however, has not yet been examined.
  
  
  METHODS
  A total of 80 patients with type 1 HRS who received a combination therapy of vasoconstrictors and albumin were enrolled into a retrospective cohort study. The effects of RRT status on clinical outcome were analyzed.
  
  
  RESULTS
  Both short-term (30 days) and long-term (180 days) survival was similar between RRT and non-RRT groups of patients, but the length of hospital stay was significantly longer among patients in the RRT group, which remain unchanged despite adjustment of status for liver transplantation.
  
  
  CONCLUSIONS
  Based on our observation, routine use of RRT may not be beneficial in patients with type 1 HRS receiving combination treatment of vasoconstrictor plus albumin. Further prospective studies are needed to validate these findings and refine the specific indications for RRT in this patient population.
authors.affiliation: Division of Nephrology, Department of Medicine, VA Loma Linda Healthcare System and Loma Linda University, Loma Linda, CA 92357. Electronic address: zhiwei.zhang@va.gov.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Division of Nephrology, Department of Medicine, VA St Louis Healthcare System and St Louis University, St Louis, MO 63106.
authors.forename: Geetha
authors.initials: G
authors.lastname: Maddukuri
authors.affiliation: Division of Nephrology, Department of Medicine, VA Loma Linda Healthcare System and Loma Linda University, Loma Linda, CA 92357.
authors.forename: Navin
authors.initials: N
authors.lastname: Jaipaul
authors.affiliation: Division of Gastroenterology, Department of Medicine, VA Loma Linda Healthcare System and Loma Linda University, Loma Linda, CA 92357. Electronic address: cindy.cai3@va.gov.
authors.forename: Cindy X
authors.initials: CX
authors.lastname: Cai
mesh_terms: D000328:Adult; D000418:Albumins / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006530:Hepatorenal Syndrome / Q000188:drug therapy*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D000418:Albumins; D014662:Vasoconstrictor Agents
keywords: Hepatorenal syndrome; Renal replacement therapy; Vasoconstrictor