Reversal of type 1 hepatorenal syndrome with the administration of midodrine and octreotide

The aim of the study was to verify the effects of the administration of an inhibitor of the release of endogenous vasodilators together with a vasocon strictor agent in patients with hepatorenal syndrome (HRS). This new medica l perspective was compared with a traditional medical approach for HRS, suc h as the infusion of nonpressor doses of dopamine to produce renal vasodila tion. Thirteen patients with type 1 HRS were enrolled in the study. Five of them were treated with the oral administration of midodrine and the parent eral administration of octreotide, In addition, the patients received SO to 100 mL of 20% human albumin solution daily for 20 days. Midodrine and octr eotide were dosed to obtain a stable increase of at least 15 mm Hg of mean arterial pressure. Eight patients were treated with the intravenous adminis tration of nonpressor doses of dopamine (2-4 mu g/kg/min) and the same dail y amount of albumin. After 20 days of treatment with midodrine and octreoti de, an impressive improvement in renal plasma flow (RPF), glomerular filtra tion rate, and urinary sodium excretion was observed in patients. This was accompanied by a significant reduction in plasma renin activity, plasma vas opressin, and plasma glucagon, No side effects were observed. Three patient s were discharged from the hospital. One of them successfully underwent liv er transplantation. One of the two remaining patients is still alive after 472 days with a preserved renal function, and the other died from terminal liver failure after 76 days. One of the two patients who were not discharge d from the hospital successfully underwent liver transplantation, and the o ther died from pneumonia after 29 days. Seven out of eight patients who wer e treated with dopamine experienced a progressive deterioration in renal fu nction and died during the first 12 days. Only one patient recovered renal function and underwent liver transplantation. In conclusion, the long-term administration of midodrine and octreotide seems to be an effective and saf e treatment of type 1 HRS in patients with cirrhosis.