Kidney Week

Abstract: TH-PO0768

Bolus vs. Continuous Dosing of Terlipressin for Hepatorenal Syndrome-AKI: Results from the HRS-HARMONY Consortium

Session Information

• AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• McAdams, Meredith C., The University of Texas Southwestern Medical Center Department of Internal Medicine, Dallas, Texas, United States

Meredith C. McAdams, MD

• Takeuchi, Tomonori, The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States

Tomonori Takeuchi, MD

• Robinson, Jevon E., Massachusetts General Hospital Department of Medicine, Boston, Massachusetts, United States

Jevon E. Robinson

• Whittaker, Sydney, Massachusetts General Hospital Department of Medicine, Boston, Massachusetts, United States

Sydney Whittaker

• Belcher, Justin Miles, Yale School of Medicine, New Haven, Connecticut, United States

Justin Miles Belcher, MD, PhD, FASN

• Frederick, Richard Todd, California Pacific Medical Center, San Francisco, California, United States

Richard Todd Frederick, MD

• Fricker, Zachary, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Zachary Fricker, MD

• Izzy, Manhal J., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Manhal J. Izzy, MD

• Neyra, Javier A., The University of Alabama at Birmingham Division of Nephrology, Birmingham, Alabama, United States

Javier A. Neyra, MD, MS, FASN

• Vargas, Hugo E., Mayo Clinic Hospital, Phoenix, Arizona, United States

Hugo E. Vargas, MD

• Velez, Juan Carlos Q., Ochsner Health, New Orleans, Louisiana, United States

Juan Carlos Q. Velez, MD, FASN

• Gonzalez, Stevan A., Baylor Scott & White All Saints Medical Center Fort Worth, Fort Worth, Texas, United States

Stevan A. Gonzalez, MD

• Allegretti, Andrew S., Massachusetts General Hospital Department of Medicine, Boston, Massachusetts, United States

Andrew S. Allegretti, MD, MS, FASN

• Teixeira, J. Pedro, The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States

J. Pedro Teixeira, MD, FASN

Group or Team Name

• HRS-HARMONY Consortium

Background

Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a frequent severe complication of decompensated cirrhosis and portal hypertension. Terlipressin, a synthetic vasopressin analogue, was FDA-approved in 2022 for the treatment of HRS-AKI and the FDA labeling recommends intermittent boluses. However, continuous infusion has also shown efficacy and may offer a better safety profile.

Methods

Adults with HRS-AKI treated with terlipressin at 16 U.S. academic centers were followed for 90 days. Overall response (per the 2015 International Club of Ascites guidelines) to terlipressin was captured, as were adverse events (AEs). Serious AEs were defined as respiratory AEs (new/worsening hypoxia, volume overload, or respiratory failure), bradycardia, and ischemic events (cardiac, gut, or digital). Gastrointestinal (GI) AEs included abdominal pain, nausea, and diarrhea. Intermittent bolus vs. continuous dosing of terlipressin was compared with regard to overall response and AE rate.

Results

243 patients were analyzed, with 207 receiving bolus terlipressin dosing and 36 a continuous infusion. Overall response rate was similar with bolus (54.6%) vs. continuous dosing (58.3%). A total of 42 subjects experienced AEs, with 38 (18.4%) in the bolus group and 4 (11.1%) in the continuous group (Table). No GI AEs were reported in the continuous group vs. 11 (5.3%) in the bolus group. A total of 19 (9.2%) respiratory AEs were reported in the bolus group vs. 4 (11.1%) in the continuous group. There were 32 total serious AEs, 28 (13.5%) with bolus dosing and 4 (11.1%) with continuous dosing.

Conclusion

Efficacy was similar in those treated with bolus dosing vs. continuous dosing. Continuous dosing showed a comparable and perhaps better safety profile, particularly regarding GI AEs. Respiratory AE rates did not differ between bolus and continuous administration in this cohort. These real-world data reinforce prior studies suggesting that continuous infusion of terlipressin may be better tolerated than bolus dosing.

Funding

• NIDDK Support