Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2025
Chronic Kidney Disease Does Not Influence Response to Terlipressin in Hepatorenal Syndrome-Acute Kidney Injury.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Uschner Frank Erhard, Schleicher Eva Maria, Passenberg Moritz, Pohl Julian, Praktiknjo Michael, Volk Anna Teresa, Karbannek Henrik, Chang Johannes, Große Karsten, Rohrer Charlotte, Labenz Christian, Maasoumy Benjamin, Jamme Paul, von Widdern Julian Cardinal, Queck Alexander, Trebicka Jonel, Engelmann Cornelius, Rashidi-Alavijeh Jassin, Bettinger Dominik, Ripoll Cristina, German Cirrhosis Study Group
Аннотация
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.
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.