(459) Terlipressin Versus Midodrine/Octreotide for Hepatorenal Syndrome

Introduction: Terlipressin is a vasopressin analogue that is approved by the Federal Drug Administration (FDA) to improve kidney function in adults with hepatorenal syndrome (HRS) with rapid reduction in kidney function. This study examines the effect of terlipressin compared to octreotide and midodrine (MO) on renal function in patients with HRS.

Methods: This single-center, retrospective, cohort study was conducted at a tertiary academic medical center that was approved by the local institutional review board. Data was collected from the electronic medical record for patients admitted from July 2018 to July 2024. Patients ≥18 years of age and admitted with ICD-9 code for cirrhosis, acute kidney injury and clinical diagnosis of HRS were included. Albumin was administered to all patients and use of terlipressin was administered based on the FDA-approved dosing regimen. Response to intervention was defined as at least a reduction in serum creatinine from baseline value. Descriptive statistics were performed and student t-test, Fisher’s exact test, χ-square test and Mann Whitney U test were conducted, where appropriate.

Results: A total of 42 patients who received terlipressin were identified during the study time period along with a control population of 30 patients. Patients in the MO group were older 61.7±14 vs. 52.1±14, p< 0.005 years, as well as 42.9% males vs. 40.0%, p=1.00. There was a greater mean total hospital length of stay of (21.7±14 vs. 15.5±8, p=0.04) and baseline serum creatinine (2.93±1.1 vs. 1.89±1.2, p< 0.01 in patients who received terlipressin. Greater number of patients had a response to therapy with terlipressin than MO (30/42 (71.4%) vs.12/30 (40.0%), p=0.0146) with a similar % decrease in serum creatinine from baseline in those who responded -34.8±21% vs. -36.1±21%, p=0.86). The number of days from start of therapy until the lowest serum creatinine was also lower in the terlipressin group 4.97±3.5 days vs. 7.92±3.7 days, p=0.02).

Conclusions: Terlipressin appears to have efficacy in improving renal function in patients with HRS when compared to the current regimen of MO. Additional larger studies would be needed to confirm the efficacy of terlipresin in improving renal function and reversing HRS.