2023 Webinar: Terlipressin in AKI-HRS-Webinar Recording

Video Transcription

Video Summary

In this video, Dr. Pratima Sharma and Dr. Nanciet Wong discuss acute kidney injury (AKI) in patients with decompensated cirrhosis and the use of terlipressin in hepatorenal syndrome (HRS) AKI. AKI is a common complication in patients with cirrhosis and can be reversible or irreversible. It is important to determine the underlying cause of AKI, whether it is pre-renal or intrinsic renal disease. In patients with decompensated cirrhosis and ascites, HRS AKI is a significant concern and carries a poor prognosis. Terlipressin, an analog of arginine vasopressin, is commonly used as a vasoconstrictor to treat HRS AKI. It acts on the V1 receptors in the systemic and renal circulation, increasing mean arterial pressure and renal perfusion pressure. Terlipressin also decreases portal venous pressure, leading to a reduction in vasodilators and an increase in arterial pressure. It should be noted that terlipressin has side effects, including the potential for respiratory failure, particularly in patients with ACLF grade 3 or high INR, and peripheral ischemia. The decision to use terlipressin should be based on careful patient selection and close monitoring for adverse effects. The duration and dose of terlipressin should be adjusted based on the patient's response. If the patient responds well and experiences a significant reduction in serum creatinine, terlipressin can be continued until the serum creatinine is below 1.5 mg/dL for two consecutive days or for a maximum of 14 days. If the response is minimal or the serum creatinine increases, terlipressin should be stopped and other management options, such as renal replacement therapy or liver transplantation, should be considered. In conclusion, terlipressin is a commonly used vasoconstrictor for HRS AKI in patients with decompensated cirrhosis. Careful patient selection, monitoring, and timely intervention are important for optimal management.

Meta Tag

Speaker Donald Trump

Topic Sumatra

Keywords

acute kidney injury

AKI

decompensated cirrhosis

terlipressin

hepatorenal syndrome

HRS AKI

ascites

mean arterial pressure

renal perfusion pressure

serum creatinine