The clinical course of patients with type 1 hepatorenal syndrome maintained on hemodialysis

Goal: Report the natural coarse of hepatorenal syndrome in 4 patients who were maintained on chronic hemodialysis. Background: The diagnosis of hepatorenal syndrome carries a grave prognosis with a mortality rate >90% and a median survival time of <2 weeks without orthotopic liver transplantation. Study: We report the clinical course of 4 patients with hepatorenal syndrome who underwent long-term (greater than 3 weeks) hemodialysis in an attempt to bridge them to orthotopic liver transplantation. The etiologies of cirrhosis were: chronic hepatitis C infection (n=2), alcoholic liver disease (n=1), and primary sclerosing cholangitis (n=1). Results: Mean survival time on hemodialysis was 236 days (range: 31 to 460 days). All patients survived their initial hospitalization and were discharged from the hospital. However, only one patient received orthotopic liver transplantation. Mean number of hospital admissions was 11 (range: 4 to 18) while receiving hemodialysis at an average rate of 2.2 (range: 1.1 to 5) admissions/patient month. Mean number of days spent in hospital while on hemodialysis support was 85 days (range: 15 to 199 days) at an average rate of 11.2 (range: 8.3 to 15) hospital days/patient month. An average of 33% (range: 26% to 48%) of the days of the prolonged survival on hemodialysis was spent in hospital. Conclusion: Although our 4 patients with hepatorenal syndrome demonstrated long-term survival with hemodialysis, their prolonged survival was at the cost of a very heavy burden of morbidity and in-patient stay. The advisability of maintenance hemodialysis in patients with hepatorenal syndrome should be judged on an individual basis.