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Title: Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: A randomized trial
Authors: Cavallin, Marta 
Kamath, Patrick S
Merli, Manuela
Fasolato, Silvano 
Toniutto, Pierluigi
Salerno, Francesco
Bernardi, Mauro
Romanelli, Roberto Giulio
Colletta, Cosimo
Salinas, Freddy
Di Giacomo, Antonio
Ridola, Lorenzo
Fornasiere, Ezio
Caraceni, Paolo
Morando, Filippo 
Piano, Salvatore 
Gatta, Angelo 
Angeli, Paolo 
Mesh headings: Albumins;Hepatorenal Syndrome;Lypressin;Midodrine;Octreotide
Secondary Mesh headings: Aged;Analysis of Variance;Drug Therapy, Combination;Female;Follow-Up Studies;Humans;Infusions, Intravenous;Kaplan-Meier Estimate;Kidney Function Tests;Liver Function Tests;Male;Middle Aged;Predictive Value of Tests;Survival Analysis;Terlipressin;Treatment Outcome
Issue Date: Aug-2015
Journal: Hepatology (Baltimore, Md.) 
Hepatorenal syndrome (HRS), a serious complication of cirrhosis, is associated with high mortality without treatment. Terlipressin with albumin is effective in the reversal of HRS. Where terlipressin is not available, as in the United States, midodrine and octreotide with albumin are used as an alternative treatment of HRS. The aim was to compare the effectiveness of terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of HRS in a randomized controlled trial. Twenty-seven patients were randomized to receive terlipressin with albumin (TERLI group) and 22 to receive midodrine and octreotide plus albumin (MID/OCT group). The TERLI group received terlipressin by intravenous infusion, initially 3 mg/24 hours, progressively increased to 12 mg/24 hours if there was no response. The MID/OCT group received midodrine orally at an initial dose of 7.5 mg thrice daily, with the dose increased to a maximum of 12.5 mg thrice daily, together with octreotide subcutaneously: initial dose 100 μg thrice daily and up to 200 μg thrice daily. Both groups received albumin intravenously 1 g/kg of body weight on day 1 and 20-40 g/day thereafter. There was a significantly higher rate of recovery of renal function in the TERLI group (19/27, 70.4%) compared to the MID/OCT group (6/21, 28.6%), P = 0.01. Improvement in renal function and lower baseline Model for End-Stage Liver Disease score were associated with better survival.
ISSN: 02709139
DOI: 10.1002/hep.27709
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