Chronic Kidney Disease Does Not Influence Response to Terlipressin in Hepatorenal Syndrome–Acute Kidney Injury
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND & AIMS: Efficacy of treatment with terlipressin and its impact on outcome in patients with hepatorenal syndrome-acute kidney injury (HRS-AKI) and chronic kidney disease (CKD) is unknown. This multicenter, retrospective, observational study aimed to investigate treatment response of terlipressin (+ albumin) in patients with HRS-AKI and CKD compared with patients without CKD. METHODS: A total of 395 patients who received albumin/terlipressin were retrospectively analyzed and stratified according to presence of CKD at baseline. The primary endpoint was a complete response to terlipressin treatment. Secondary endpoints included adverse events, need for renal replacement therapy and 12-month liver transplantation-free survival. RESULTS: A total of 37.6% of patients with CKD and 45.6% of patients without CKD (P = .201) had complete treatment response. CKD had no influence on treatment response to terlipressin (subdistribution hazard ratio [sHR], 0.80 [95% confidence interval (CI), 0.58-1.10]; P = .171). Only delta serum creatinine was significantly associated with complete treatment response to terlipressin (sHR, 0.59 [95% CI, 0.47-0.74]; P < .001) without more complications overall (19.8% vs 15.3%; P = .350). However, patients with CKD had more pulmonary edema (5.9% vs 1.7%; P = .036). Mortality (30 days: 32.7% vs 28.6%; P = .450; 1 year: 43.6% vs 41.5%; P = .727) as well as need for renal replacement therapy during follow-up (26.7% vs 22.8%; P = .498) was similar between groups. After adjusting for Model for End-Stage Liver Disease score and treatment response, CKD did not impact survival in patients with HRS-AKI (sHR, 1.08 [95% CI, 0.63-1.72]; P = .759) considering liver transplantation as competing event. CONCLUSIONS: CKD does not adversely affect treatment response to terlipressin or survival in patients with HRS-AKI. CLINICALTRIALS: gov, Number: NCT06161766.
Authors: Frank Erhard Uschner, Eva Maria Schleicher, Moritz Passenberg, Julian Pohl, Michael Praktiknjo, Anna Teresa Volk, Henrik Karbannek, Johannes Chang, Karsten Große, Charlotte Rohrer, Christian Labenz, Benjamin Maasoumy, Paul Jamme, Julian Cardinal von Widdern, Alexander Queck, Jonel Trebicka, Cornelius Engelmann, Jassin Rashidi-Alavijeh, Dominik Bettinger, Cristina Ripoll, Nina Böhling, Maximilian Joseph Brol, Tony Bruns, Marko Damm, Jan Hendrik Harten, Christian Jansen, Christian M. Lange, Lauin Mustafa, Marcus Maximilian Mücke, Sina Oesinghaus, Sarah Schütte, Andreas Stallmach, Christoph Welsch, Alexander Zipprich
Institutions: University of Münster, University Hospital Münster, University Medical Center of the Johannes Gutenberg University Mainz, University of Duisburg-Essen, Charité - Universitätsmedizin Berlin, Goethe University Frankfurt, University Hospital Frankfurt, Jena University Hospital, University of Bonn, University Hospital Bonn, Universitätsklinikum Aachen, RWTH Aachen University, University of Freiburg, University Medical Center Freiburg, Medizinische Hochschule Hannover, LMU Klinikum, Ludwig-Maximilians-Universität München, University Hospital in Halle, Martin Luther University Halle-Wittenberg
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,470
Awards: Frühelektive TIPSAnlage bei Patient*innen mit einer erstmalig hydropisch dekompensierten Leberzirrhose (eTIPS), Therapie des hepatorenalen Syndroms akuten Nierenversagens (HRSAKI) mit transjugulärem intrahepatischem portosystemischem Shunt bei Patienten mit Leberzirrhose: eine randomisierte kontrollierte Studie., AcceleRating the Translation of virtual twins towards a pErsonalised Management of fatty lIver patients
OpenAlex ID: W4416419137