Original InvestigationPathogenesis and Treatment of Kidney DiseaseTherapeutic Response to Vasoconstrictors in Hepatorenal Syndrome Parallels Increase in Mean Arterial Pressure: A Pooled Analysis of Clinical Trials
Section snippets
Review Strategy and Study Selection
The electronic databases of PubMed, The Cochrane Library, Web of Science, and LILACS were searched for publications between 1966 and January 2011 that evaluated the efficacy of vasoconstrictor therapy for the reversal of HRS type 1 or 2. We searched for articles with the key words “hepatorenal syndrome” and cross-referenced them with “treatment,” “vasoconstrictor therapy,” “reversal,” “liver cirrhosis,” “terlipressin,” “ornipressin,” “vasopressin,” “midodrine,” “octreotide,” “dopamine,”
Study Characteristics
Table 1 lists general characteristics of the included studies. The series included publications between 1998 and 2010. Only 1 study was conducted, partially, in the United States.7 Two were from India,32, 33 1 was from Mexico,44 2 were from Canada,34, 43 and the rest were from Europe. Ten studies were conducted under a dual-arm design, whereas 11 studies had a single treatment arm. Because 6 of the single-arm studies reported their results in 2 subgroups based on either responder status or
Discussion
Our analysis shows a strong correlation between the increase in MAP during vasoconstrictor therapy in patients with HRS and therapeutic response. Improvement in kidney function tightly correlates with the magnitude of increase in MAP. Although these findings seem intuitive, no previous study was designed to specifically explore this relationship. Of note, several studies individually reported a similar association between improvement in systemic hemodynamics and HRS reversal.8, 27, 29, 30, 31,
Acknowledgements
A preliminary version of this study appeared in abstract form at the 43rd Annual Meeting and Scientific Exposure of the American Society of Nephrology Kidney Week 2010, November 16-21, 2010, Denver, CO.
We thank Dr Michael E. Ullian for critical review of this manuscript.
Support: This project was supported by the South Carolina Clinical & Translational Research Institute, Medical University of South Carolina's Clinical and Translational Science Award, National Institutes of Health (NIH)/National
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Originally published online September 29, 2011.