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Abstract: PO0269

Responsiveness to Vasoconstrictor Therapy in Hepatorenal Syndrome Type 1

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Ledoux, Jason R., Ochsner Medical Center - New Orleans, New Orleans, Louisiana, United States
  • Kanduri, Swetha Rani, Ochsner Medical Center - New Orleans, New Orleans, Louisiana, United States
  • Braga, Juarez R., University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Tayebi, Kasra, The University of Queensland Ochsner Clinical School New Orleans, New Orleans, Louisiana, United States
  • Mundy, Destiney A., Ochsner Medical Center - New Orleans, New Orleans, Louisiana, United States
  • Scharwath, Kevin, Ochsner Medical Center - New Orleans, New Orleans, Louisiana, United States
  • Poole, Kateryna A., Ochsner Medical Center - New Orleans, New Orleans, Louisiana, United States
  • Wentowski, Catherine, Ochsner Medical Center - New Orleans, New Orleans, Louisiana, United States
  • Velez, Juan Carlos Q., The University of Queensland Ochsner Clinical School New Orleans, New Orleans, Louisiana, United States
Background

We previously reported that raising mean arterial pressure (MAP) during treatment of hepatorenal syndrome type 1 (HRS-1) with vasoconstrictors (VC) is associated with improvement in kidney function. However, the optimal MAP target and factors associated with response to VC remain unclear.

Methods

Records from hospitalized patients with HRS-1 treated with VC without shock were reviewed. We selected those who achieved ≥ 5 mmHg rise in MAP within 48 hours. We examined the relationship between the mean MAP achieved during the 1st 72 hours of VC therapy and the change in kidney function at 7-14 days as determined by serum creatinine (sCr). The primary (1ry) endpoint was > 30% reduction in sCr without need for dialysis or death at day 14. Secondary (2ry) endpoint was change in slope of sCr from positive (worsening) to negative (improving) by day 7.

Results

A total of 74 patients with HRS-1 treated for 2-7 days with either midodrine/octreotide (n=28) or norepinephrine (n=46) were included. Median age was 53 (IQR 46-60), 41% were female and 47% had alcoholic cirrhosis. At start of VC, median MAP was 70 mmHg (IQR 66-73) and median sCr was 3.8 mg/dL (IQR 2.6-4.9). When analyzed based on tertiles of mean MAP increment (5-9, 10-14, ≥ 15 mmHg), there was a significant trend for greater reduction in sCr with greater rise in MAP (ANOVA, p<0.0001). When analyzed based on tertiles of achieved absolute MAP (65-74, 75-84, ≥ 85 mmHg), there was a non-significant trend for greater reduction in sCr with higher absolute MAP (p=0.06). The 1ry and 2ry endpoints were met by 25 (34%) and 42 (57%) patients, respectively. By multivariate logistic regression analysis, mean MAP rise in 1st 72 hrs had an OR 1.18 (95% CI 1.04-1.34; p=0.012) for meeting the 1ry endpoint and an OR 1.22 (95% CI 1.07-1.40; p=0.003) for the 2ry endpoint. Neither age, sex, MELD score, baseline sCr nor baseline MAP were predictive of any endpoint.

Conclusion

Greater magnitude of rise in MAP with VC therapy in HRS-1 is associated with greater improvement in kidney function. Targeting an increment of MAP ≥ 15 mmHg may lead to favorable kidney-related outcomes. No other demographic or clinical variables predicts response to VC therapy, highlighting the need for biomarker development.