Hepatorenal Syndrome
A form of functional kidney failure in patients with advanced liver disease (cirrhosis) and portal hypertension, characterized by intense renal vasoconstriction without structural kidney damage. Type 1 HRS (HRS-AKI) is rapidly progressive with poor prognosis if untreated.
Quick Answer
What it is
A form of functional kidney failure in patients with advanced liver disease (cirrhosis) and portal hypertension, characterized by intense renal vasoconstriction without structural kidney damage. Type 1 HRS (HRS-AKI) is rapidly progressive with poor prognosis if untreated.
Key findings
- Grade A: HRS Reversal (CONFIRM Trial) (Terlipressin (Terlivaz))
- Grade A: HRS Reversal (Pooled Analysis) (Terlipressin (Terlivaz))
- Grade A: Serum Creatinine Improvement (Terlipressin (Terlivaz))
Safety
- SAFETY CONCERN: CONFIRM trial showed increased serious respiratory adverse events with terlipressin.
- Black box warning: Risk of respiratory failure.
- Avoid use if oxygen saturation <90%.
ℹ️ Quick Facts
Quick Facts: Hepatorenal Syndrome
- Supplements Studied:1
1 supps · 4 outcomes
Detailed Outcomes
A
HRS Reversal (CONFIRM Trial)
CONFIRM Phase 3 trial (n=300): Verified HRS reversal achieved in 32% terlipressin vs 17% placebo (P=0.012). Led to FDA approval. Mean serum creatinine improvement significantly greater with terlipressin. Effects maintained through study duration.
large↑Improves
A
HRS Reversal (Pooled Analysis)
Pooled OT-0401 + REVERSE trials (n=308): HRS reversal 27% terlipressin vs 14% placebo (P=0.004). Mean serum creatinine difference -53.0 umol/L favoring terlipressin (P<0.0001). Consistent effect across both trials.
large↑Improves
A
Serum Creatinine Improvement
CONFIRM trial: Significant improvement in renal function with terlipressin vs placebo. 29% achieved kidney function improvement vs 16% placebo. Early treatment (<48h from diagnosis) associated with better outcomes.
moderate↑Improves
A
Respiratory Failure Risk
SAFETY CONCERN: CONFIRM trial showed increased serious respiratory adverse events with terlipressin. Black box warning: Risk of respiratory failure. Avoid use if oxygen saturation <90%. Higher risk in ACLF grade 3 patients. Patients with SCr >5 mg/dL unlikely to benefit.
moderate↑Worsens