Influence of Albumin Treatment Duration on Outcome of Terlipressin Therapy in Patients With
HRS
‐
AKI
Eva Maria Schleicher, Christian Labenz, Frank Erhard Uschner, Julian Pohl, Moritz Passenberg, Michael Praktiknjo, Marcus Maximilian Mücke, Henrik Karbannek, Nina Böhling, Karsten Große, Marlene Reincke, Sarah Schütte, Paul Jamme, Julian Cardinal von Widdern, Christoph Welsch, Jonel Trebicka, Cornelius Engelmann, Jassin Rashidi‐Alavijeh, Cristina Ripoll, Dominik Bettinger, ABSTRACT
Background and Aims
Volume expansion with albumin is recommended to establish a diagnosis of hepatorenal syndrome–acute kidney injury (HRS‐AKI). The optimal duration of albumin administration is debated and requires balancing the risk of overtreatment with the need for timely diagnosis and treatment. Therefore, this study aimed to compare the impact of different albumin treatment durations on terlipressin response and the prognosis of patients with HRS‐AKI treated with terlipressin and albumin.
Methods
This multicenter, retrospective secondary analysis included patients with suspected HRS‐AKI who were treated with terlipressin and albumin at 12 German centers. One hundred forty five patients were available for further analysis. The cohort was dichotomized into patients treated with albumin for < 24 h and for 24–60 h before initiation of terlipressin. Patients were followed for treatment response to terlipressin, need for haemodialysis (HD), survival, or liver transplantation (LT).
Results
Median MELD score of the cohort was 25 [IQR 21; 31]. During follow‐up, 59 patients (40.7%) achieved a complete response to treatment with terlipressin, and 96 patients (66.2%) died or received an LT. Response rates to terlipressin therapy did not differ between albumin treatment groups (< 24 h vs. 24–60 h). In multivariable competing risk models, treatment duration of albumin was not associated with any response to terlipressin, considering death and LT as competing events. Of note, albumin treatment duration did not affect HD−/LT‐free survival.
Conclusion
Extending albumin treatment beyond 24 h had no impact on treatment response to terlipressin and albumin or HD‐/LT‐free survival in patients with HRS‐AKI.
Clinical Trial Number
NCT 06161766