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The Current Management of Hepatorenal Syndrome–Acute Kidney Injury in the United States and the Potential of Terlipressin

Acute kidney injury (AKI) in the setting of cirrhosis (hepatorenal syndrome [HRS]–AKI) is a severe and often fatal complication of end‐stage liver disease. The goals of treatment are to reverse renal failure and prolong survival in patients who are critically ill. However, interventions have limited...

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Autores principales: Flamm, Steven L., Brown, Kimberly, Wadei, Hani M., Brown, Robert S., Kugelmas, Marcelo, Samaniego‐Picota, Milagros, Burra, Patrizia, Poordad, Fred, Saab, Sammy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457138/
https://www.ncbi.nlm.nih.gov/pubmed/33848394
http://dx.doi.org/10.1002/lt.26072
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author Flamm, Steven L.
Brown, Kimberly
Wadei, Hani M.
Brown, Robert S.
Kugelmas, Marcelo
Samaniego‐Picota, Milagros
Burra, Patrizia
Poordad, Fred
Saab, Sammy
author_facet Flamm, Steven L.
Brown, Kimberly
Wadei, Hani M.
Brown, Robert S.
Kugelmas, Marcelo
Samaniego‐Picota, Milagros
Burra, Patrizia
Poordad, Fred
Saab, Sammy
author_sort Flamm, Steven L.
collection PubMed
description Acute kidney injury (AKI) in the setting of cirrhosis (hepatorenal syndrome [HRS]–AKI) is a severe and often fatal complication of end‐stage liver disease. The goals of treatment are to reverse renal failure and prolong survival in patients who are critically ill. However, interventions have limited efficacy, and mortality rates remain high. In the United States, the mainstay of pharmacologic therapy consists of the off‐label use of vasoconstrictive agents in combination with plasma expanders, a strategy that produces modest effects. Liver transplantation is the ultimate solution but is only an option in a minority of patients because contraindications to transplantation are common and organ availability is limited. Renal replacement therapy is a temporary option but is known to confer an extremely poor short‐term prognosis in patients with HRS‐AKI and at best serves as a bridge to liver transplantation for the minority of patients who are transplantation candidates. The high mortality rate associated with HRS‐AKI in the United States is a reflection of the suboptimal standard of care. Improved therapeutic options to treat HRS‐AKI are sought. Terlipressin is a drug approved in Europe for treatment of HRS‐AKI and supported by recommendations for first‐line therapy by some liver societies and experts around the world. This review article will discuss the substantial unmet medical need associated with HRS‐AKI and the potential benefits if terlipressin was approved in the United States.
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spelling pubmed-84571382021-09-27 The Current Management of Hepatorenal Syndrome–Acute Kidney Injury in the United States and the Potential of Terlipressin Flamm, Steven L. Brown, Kimberly Wadei, Hani M. Brown, Robert S. Kugelmas, Marcelo Samaniego‐Picota, Milagros Burra, Patrizia Poordad, Fred Saab, Sammy Liver Transpl Review Articles and Practice‐Based Recommendations Acute kidney injury (AKI) in the setting of cirrhosis (hepatorenal syndrome [HRS]–AKI) is a severe and often fatal complication of end‐stage liver disease. The goals of treatment are to reverse renal failure and prolong survival in patients who are critically ill. However, interventions have limited efficacy, and mortality rates remain high. In the United States, the mainstay of pharmacologic therapy consists of the off‐label use of vasoconstrictive agents in combination with plasma expanders, a strategy that produces modest effects. Liver transplantation is the ultimate solution but is only an option in a minority of patients because contraindications to transplantation are common and organ availability is limited. Renal replacement therapy is a temporary option but is known to confer an extremely poor short‐term prognosis in patients with HRS‐AKI and at best serves as a bridge to liver transplantation for the minority of patients who are transplantation candidates. The high mortality rate associated with HRS‐AKI in the United States is a reflection of the suboptimal standard of care. Improved therapeutic options to treat HRS‐AKI are sought. Terlipressin is a drug approved in Europe for treatment of HRS‐AKI and supported by recommendations for first‐line therapy by some liver societies and experts around the world. This review article will discuss the substantial unmet medical need associated with HRS‐AKI and the potential benefits if terlipressin was approved in the United States. John Wiley and Sons Inc. 2021-07-14 2021-08 /pmc/articles/PMC8457138/ /pubmed/33848394 http://dx.doi.org/10.1002/lt.26072 Text en © 2021 The Authors. Liver Transplantation published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Review Articles and Practice‐Based Recommendations
Flamm, Steven L.
Brown, Kimberly
Wadei, Hani M.
Brown, Robert S.
Kugelmas, Marcelo
Samaniego‐Picota, Milagros
Burra, Patrizia
Poordad, Fred
Saab, Sammy
The Current Management of Hepatorenal Syndrome–Acute Kidney Injury in the United States and the Potential of Terlipressin
title The Current Management of Hepatorenal Syndrome–Acute Kidney Injury in the United States and the Potential of Terlipressin
title_full The Current Management of Hepatorenal Syndrome–Acute Kidney Injury in the United States and the Potential of Terlipressin
title_fullStr The Current Management of Hepatorenal Syndrome–Acute Kidney Injury in the United States and the Potential of Terlipressin
title_full_unstemmed The Current Management of Hepatorenal Syndrome–Acute Kidney Injury in the United States and the Potential of Terlipressin
title_short The Current Management of Hepatorenal Syndrome–Acute Kidney Injury in the United States and the Potential of Terlipressin
title_sort current management of hepatorenal syndrome–acute kidney injury in the united states and the potential of terlipressin
topic Review Articles and Practice‐Based Recommendations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457138/
https://www.ncbi.nlm.nih.gov/pubmed/33848394
http://dx.doi.org/10.1002/lt.26072
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