title: Therapeutic alternatives for the treatment of type 1 hepatorenal syndrome: A Delphi technique-based consensus.
abstract: OBJECTIVE
  To propose several alternatives treatment of type 1 hepatorenal syndrome (HRS-1) what is the most severe expression of circulatory dysfunction on patients with portal hypertension.
  
  
  METHODS
  A group of eleven gastroenterologists and nephrologists performed a structured analysis of available literature. Each expert was designated to review and answer a question. They generated draft statements for evaluation by all the experts. Additional input was obtained from medical community. In order to reach consensus, a modified three-round Delphi technique method was used. According to United States Preventive Services Task Force criteria, the quality of the evidence and level of recommendation supporting each statement was graded.
  
  
  RESULTS
  Nine questions were formulated. The available evidence was evaluated considering its quality, number of patients included in the studies and the consistency of its results. The generated questions were answered by the expert panel with a high level of agreement. Thus, a therapeutic algorithm was generated. The role of terlipressin and norepinephrine was confirmed as the pharmacologic treatment of choice. On the other hand the use of the combination of octreotide, midodrine and albumin without vasoconstrictors was discouraged. The role of several other options was also evaluated and the available evidence was explored and discussed. Liver transplantation is considered the definitive treatment for HRS-1. The present consensus is an important effort that intends to organize the available strategies based on the available evidence in the literature, the quality of the evidence and the benefits, adverse effects and availability of the therapeutic tools described.
  
  
  CONCLUSIONS
  Based on the available evidence the expert panel was able to discriminate the most appropriate therapeutic alternatives for the treatment of HRS-1.
authors.affiliation: Juan P Arab, Rodrigo Wolff, Marco Arrese, Carlos Benítez, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 833-0024, Chile.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Arab
authors.affiliation: Juan P Arab, Rodrigo Wolff, Marco Arrese, Carlos Benítez, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 833-0024, Chile.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Claro
authors.affiliation: Juan P Arab, Rodrigo Wolff, Marco Arrese, Carlos Benítez, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 833-0024, Chile.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Arancibia
authors.affiliation: Juan P Arab, Rodrigo Wolff, Marco Arrese, Carlos Benítez, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 833-0024, Chile.
authors.forename: Jorge
authors.initials: J
authors.lastname: Contreras
authors.affiliation: Juan P Arab, Rodrigo Wolff, Marco Arrese, Carlos Benítez, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 833-0024, Chile.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gómez
authors.affiliation: Juan P Arab, Rodrigo Wolff, Marco Arrese, Carlos Benítez, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 833-0024, Chile.
authors.forename: Cristian
authors.initials: C
authors.lastname: Muñoz
authors.affiliation: Juan P Arab, Rodrigo Wolff, Marco Arrese, Carlos Benítez, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 833-0024, Chile.
authors.forename: Leyla
authors.initials: L
authors.lastname: Nazal
authors.affiliation: Juan P Arab, Rodrigo Wolff, Marco Arrese, Carlos Benítez, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 833-0024, Chile.
authors.forename: Eric
authors.initials: E
authors.lastname: Roessler
authors.affiliation: Juan P Arab, Rodrigo Wolff, Marco Arrese, Carlos Benítez, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 833-0024, Chile.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Wolff
authors.affiliation: Juan P Arab, Rodrigo Wolff, Marco Arrese, Carlos Benítez, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 833-0024, Chile.
authors.forename: Marco
authors.initials: M
authors.lastname: Arrese
authors.affiliation: Juan P Arab, Rodrigo Wolff, Marco Arrese, Carlos Benítez, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 833-0024, Chile.
authors.forename: Carlos
authors.initials: C
authors.lastname: Benítez
keywords: Consensus; Delphi; Evidence-based medicine; Hepatorenal syndrome; Treatment