Terlipressin in the management of adults with hepatorenal syndrome-acute kidney injury (HRS-AKI).

IF 3.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Expert Review of Gastroenterology & Hepatology Pub Date : 2023-07-01 Epub Date: 2023-11-23 DOI:10.1080/17474124.2023.2273494

Anand V Kulkarni, Jason Lee, K Rajender Reddy

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引用次数: 0

Abstract

Introduction: Kidney is the most common extra-hepatic organ involved in patients with advanced liver cirrhosis and acute-on-chronic liver failure. Hepatorenal syndrome-acute kidney injury (HRS-AKI) accounts for most hospitalizations, and liver transplantation (LT) remains the ultimate and long-term treatment in such patients. However, HRS-AKI, being a functional renal failure, has a fair chance of reversal, and as such, patients who achieve reversal of HRS-AKI have better outcomes post-LT.

Areas covered: In this review, we discuss the pharmacokinetics, pharmacodynamics and evidence to support the use of terlipressin in HRS-AKI while we also address predictors of response and the associated adverse events. Further, we discuss the role of terlipressin in the context of LT.

Expert opinion: The recommended treatment for HRS-AKI reversal includes a vasoconstrictor in addition to volume expansion with albumin. The three vasoconstrictor regimens generally used to treat HRS-AKI include octreotide plus midodrine, noradrenaline, and terlipressin. Of these, terlipressin is a widely used drug and has been recently approved by US Food and Drug Administration (USFDA) for HRS-AKI. Terlipressin is the most effective drug for HRS-AKI reversal and is associated with a decreased need for renal replacement therapy pre- and post-transplant. Furthermore, terlipressin responders have improved transplant-free and post-transplant survival.

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特利加压素治疗成人肝肾综合征急性肾损伤（HRS-AKI）。

引言：肾脏是晚期肝硬化和急慢性肝功能衰竭患者最常见的肝外器官。肝肾综合征急性肾损伤（HRS-AKI）是大多数住院患者的原因，肝移植（LT）仍然是此类患者的最终和长期治疗方法。然而，HRS-AKI作为一种功能性肾衰竭，有相当大的逆转机会，因此，HRS-AKI逆转的患者在LT后有更好的结果。涵盖的领域：在这篇综述中，我们讨论了支持在HRS-AKI中使用特利加压素的药代动力学、药效学和证据，同时我们还讨论了反应和相关不良事件的预测因素。此外，我们还讨论了特利加压素在LT中的作用。专家意见：推荐的HRS-AKI逆转治疗方法除了用白蛋白扩大体积外，还包括血管收缩剂。通常用于治疗HRS-AKI的三种血管收缩剂方案包括奥曲肽加米多林、去甲肾上腺素和特利加压素。其中，特利加压素是一种广泛使用的药物，最近已被美国食品药品监督管理局（USFDA）批准用于HRS-AKI。特利加压素是逆转HRS-AKI最有效的药物，与移植前后对肾脏替代治疗的需求减少有关。此外，特利加压素应答者提高了无移植和移植后的存活率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Gastroenterology & Hepatology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.80

自引率

2.60%

发文量

审稿时长

6-12 weeks

期刊介绍： The enormous health and economic burden of gastrointestinal disease worldwide warrants a sharp focus on the etiology, epidemiology, prevention, diagnosis, treatment and development of new therapies. By the end of the last century we had seen enormous advances, both in technologies to visualize disease and in curative therapies in areas such as gastric ulcer, with the advent first of the H2-antagonists and then the proton pump inhibitors - clear examples of how advances in medicine can massively benefit the patient. Nevertheless, specialists face ongoing challenges from a wide array of diseases of diverse etiology.