Terlipressin for the treatment of hepatorenal syndrome in patients with cirrhosis

Introduction: Hepatorenal syndrome (HRS) is a phenotype of renal failure that often occurs in patients with cirrhosis and ascites. HRS develops mainly as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output. Areas covered: Nowadays several small studies and some randomized control studies have shown that terlipressin plus albumin improves renal function in patients with HRS, as well as improving short-term survival in these patients. Terlipressin was most commonly used by intravenous boluses moving from an initial dose of 0.5 - 1 mg every 4 h to 3 mg every 4 h in the case of nonresponse. However, the best way to use terlipressin in these patients is still under evaluation. There are some preliminary data showing that terlipressin given by continuous intravenous infusion is more effective and better tolerated than when it is given by intravenous boluses. Expert opinion: Future studies should confirm this difference and outline the best way to use this drug in the treatment of HRS. However, the available data suffice to state that use of terlipressin plus albumin has really changed the management of HRS in patients with cirrhosis