Abstract: SA-PO1188
Impact of CKD on Real-World Outcomes in Patients Treated with Terlipressin for Hepatrorenal Syndrome (HRS)-AKI
Session Information
- CKD: Biomarkers and Emerging Tools for Diagnosis and Monitoring
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Huang, Xingyue, Mallinckrodt PLC, Bridgewater, New Jersey, United States
- Patidar, Kavish Rohit, Houston Methodist Hospital, Houston, Texas, United States
- Wong, Robert, Stanford University School of Medicine, Stanford, California, United States
- Barritt, Alfred Sidney, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
- Rajkumar, Rahul, Boston Strategic Partners Inc, Boston, Massachusetts, United States
- Lilley, Jonathan, Boston Strategic Partners Inc, Boston, Massachusetts, United States
- Panaccio, Mary P, Mallinckrodt PLC, Bridgewater, New Jersey, United States
Background
AKI is common in cirrhosis; hepatorenal syndrome-AKI (HRS-AKI) is a rare, severe subtype linked to portal hypertension and advanced decompensation. However, little is known about how pre-existing chronic kidney disease (CKD) impacts real-world treatment outcomes in patients with HRS-AKI treated with terlipressin.
Methods
Adults hospitalized with HRS-AKI who received terlipressin for ≥2 days between Sep 15, 2022—Oct 31, 2024 were identified from the Premier U.S. hospital database using ICD-10, drug, and billing codes. CKD was identified using ICD-10 N18.x from a 90-day lookback prior to HRS-AKI hospitalization (ICD-10: K76.7). Patient characteristics and key clinical outcomes were compared between those with and without CKD using Chi-square or Mann-Whitney U tests, as appropriate.
Results
Among 206 patients included (median age 56.0 years [IQR: 47–65], 67.0% male), 40.3% (n=83) had pre-existing CKD. Patients with CKD were older than non-CKD patients (62.0 vs. 53.0 years, p<0.001). Type 2 diabetes and hypertension were more prevalent in CKD patients (48.2% vs. 14.6% and 77.1% vs. 34.1%, respectively; both p<0.001). First-line terlipressin use was similar by CKD status (17.9% non-CKD vs. 13.3% CKD; p=0.487) with a median duration of 4 days in both groups. Diuretic use during hospitalization was higher in CKD patients (61.4% vs. 37.4%, p=0.012). Hospital length of stay and ICU admission rates were comparable. Among those with available lab data, serum creatinine declined by 37.1% in non-CKD and 47.6% in CKD patients (p=0.44). HRS reversal rates were higher in CKD vs. non-CKD (66.7% vs. 44.8%), although not significant (p=0.445), while in-hospital mortality (15.7% vs. 22.0%), hospice discharge (13.3% vs. 13.0%) and home discharge (44.6% vs. 47.2%) were similar across groups (NS). Renal replacement therapy was more commonly used in CKD patients, though not significantly (33.7% vs. 22.8%, p=0.115).
Conclusion
In this real-world cohort, more than one-third had pre-existing CKD. Clinical outcomes—including HRS reversal, renal recovery, in-hospital mortality, and home discharge—were not significantly different between CKD and non-CKD patients, suggesting that terlipressin is effective in patients with HRS-AKI, including those with pre-existing CKD, supporting its use across diverse real-world populations.
Funding
- Commercial Support – Mallinckrodt Pharmaceuticals