Document Detail

Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome.
MedLine Citation:
PMID:  18027874     Owner:  NLM     Status:  MEDLINE    
Patients with advanced cirrhosis and ascites are characterized by circulatory dysfunction with splanchnic vasodilatation and renal vasoconstriction, which often lead to ascites. The vasoconstrictor terlipressin improves renal function in hepatorenal syndrome (HRS). The aim of this study was to evaluate if terlipressin also improves renal function in patients with ascites without HRS. Twenty-three patients with cirrhosis participated; 15 with nonrefractory ascites were randomized to either terlipressin (N group, n = 11) or a placebo (P group, n = 4), and 8 had refractory ascites and received terlipressin (R group). The glomerular filtration rate (GFR), sodium clearance (C(Na)), lithium clearance (C(Li)), osmolal clearance (C(Osm)), and urine sodium concentration (U(Na)) were assessed before and after the injection of 2 mg of terlipressin or the placebo. GFR increased in the N group (69 +/- 19 versus 92 +/- 25 mL/min, P < 0.005) and in the R group (31 +/- 19 versus 41 +/- 31 mL/min, P < 0.05) after terlipressin. In the N group, terlipressin induced an increase in C(Na) (0.89 +/- 0.21 versus 1.52 +/- 1.45 mL/min, P < 0.05), C(Li) (17.3 +/- 8.9 versus 21.5 +/- 11.6 mL/min, P < 0.05), and C(Osm) (2.10 +/- 0.81 versus 3.06 +/- 2.0 mL/min, P < 0.05). In the R group, terlipressin induced an increase in C(Na) (0.11 +/- 0.18 versus 0.35 +/- 0.40 mL/min, P < 0.05) and C(Li) (5.5 +/- 4.2 versus 9.5 +/- 8.55 mL/min, P < 0.05). U(Na) increased in both groups after terlipressin (P < 0.005). Plasma norepinephrine (P < 0.05) and renin (P < 0.05) decreased after terlipressin. All parameters remained unchanged after the placebo. Conclusion: The vasopressin 1 receptor agonist terlipressin improves renal function and induces natriuresis in patients with cirrhosis and ascites without HRS. Vasoconstrictors may represent a novel future treatment modality for these patients.
Aleksander Krag; Søren Møller; Jens H Henriksen; Niels-Henrik Holstein-Rathlou; Fin Stolze Larsen; Flemming Bendtsen
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Hepatology (Baltimore, Md.)     Volume:  46     ISSN:  1527-3350     ISO Abbreviation:  Hepatology     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-12-06     Completed Date:  2008-01-10     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  8302946     Medline TA:  Hepatology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1863-71     Citation Subset:  IM    
Department of Gastroenterology, Hvidovre Hospital, Denmark.
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MeSH Terms
Ascites / etiology
Double-Blind Method
Glomerular Filtration Rate / drug effects
Hepatorenal Syndrome
Kidney / blood supply,  drug effects,  physiopathology*
Kidney Diseases / drug therapy*,  etiology
Liver Cirrhosis, Alcoholic / complications*
Lypressin / analogs & derivatives*,  pharmacology,  therapeutic use
Middle Aged
Receptors, Vasopressin / drug effects
Recovery of Function
Vasoconstrictor Agents / pharmacology,  therapeutic use*
Reg. No./Substance:
0/Receptors, Vasopressin; 0/Vasoconstrictor Agents; 14636-12-5/terlipressin; 50-57-7/Lypressin
Comment In:
Hepatology. 2007 Dec;46(6):1685-7   [PMID:  18046716 ]
Hepatology. 2008 Aug;48(2):686   [PMID:  18666233 ]

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