Role of oral Midodrine in preventing hepatorenal syndrome in Child-Turcotte-Pugh class C cirrhotics: a pilot study
Gastroenterology and Hepatology from Bed to Bench,
Vol. 17 No. 4 (2024),
2 December 2024
https://doi.org/10.22037/ghfbb.v17i4.3019
Abstract
Aim: The purpose of the study was to assess benefits of oral midodrine in the role of primary prevention of hepatorenal syndrome (HRS) in Child-Turcotte-Pugh Class C (CTP-C) cirrhotics.
Background: The present non-randomized pilot study was designed for primary prevention of HRS as there is absence of an effective and definite treatment for this complication of cirrhosis to date other than liver transplant (LT).
Methods: This study effectively involved 30 patients each enrolled in interventional and control arms suffering from liver cirrhosis CTP-C with normal renal function and having a mean arterial pressure (MAP) < 80 mmHg who were subjected to clinical examination and baseline blood investigations. The mean daily dosage of midodrine used across the study group was 16.75 mg.
Results: At the end of 4 months of study, 11 individuals completed the study without attaining any endpoints from the control group while 23 accomplished it from the interventional arm. Nearly 50 % patients required a midodrine dose of 7.5 mg 8th hourly while the rest attained the targeted MAP with lower doses. By increasing MAP, the rate of HRS development during the study period (i.e. 4 months) was found to be significantly reduced in patients from interventional arm. The number needed to treat (NNT) observed in survival analysis to prevent one death was found to be 7.6.
Conclusion: This study successfully established the role oral midodrine in primary prevention of HRS in cirrhotics at high risk. Midodrine was well tolerated with no significant adverse effects in patients under study.
- Midodrine
- Hepatorenal syndrome
- Cirrhotics
How to Cite
References
Salerno F, Gerbes A, Gines P, et al. Diagnosis, prevention and treatment of HRS in cirrhosis a consensus workshop of the International Ascites Club. Gut 2007;56:1310–1318.
Zita G, Florence W. Hepatorenal Syndrome (Chapter 8). In: Lerma EV, Sparks MA. and TOPF JM, eds. Nephrology Secrets (Fourth Edition). Elseveir Inc; 2019:59-68.
Matthias P, Michael T, et al. Cancer & liver cirrhosis: implications on prognosis & management. ESMO Open 2016,1:000042:1-11.
Flamm SL, Brown K, Wadei HM et al. The current management of hepatorenal syndrome–acute kidney injury in the United States and the potential of terlipressin. Liver Transpl 2021;27:1191–1202.
Monika G, Pere G, Gloria FE, Pau S, et al. Reversibilty of HRS by prolonged administration of Ornipressin & Plasma Vol Expansion. Hepatol 1998;27:35-41.
Xingrong Z, Yunwen L, Peipei W, Lihua Z, et al. Mean arterial pressure drop is an independent risk factor of HRS in patients with HBV- ACLF. European J Gastroenterol Hepatol 2022;34:576-584.
EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. Clinical Practice Guidelines 2010;53:397-417.
Maddukuri G, Cai CX, Munigala S, Mohammadi F, Zhang Z. Targeting an early and substantial increase in mean arterial pressure is critical in the management of type 1 hepatorenal syndrome: a combined retrospective and pilot study. Dig Dis Sci 2014;59: 471–481.
Olson JC, Karvellas CJ. Critical care management of the patient with cirrhosis awaiting liver transplant in the intensive care unit. Liver Transpl 2017;23:1465-1476.
Rakhi M. Cirrhosis with septic shock responds better to high than low MAP targeting. virtual live meeting of the American association for the study of liver diseases (AASLD). Gastroenterology 2021;12-15.
Paolo A, Roberta V, Donatella P, Andrea B et al. Acute effects of the oral administration of midodrine, an a-adrenergic agonist, on renal hemodynamics and renal function in cirrhotic patients with ascites. Hepatol 1998;28:937-43.
Artzner T, Michard B, et al. LT for Critically Ill Cirrhotic patients: overview & pragmatic proposals. World J Gastroenterol 2018; 24: 5203-5214
Fleming KM, Aithal GP, Card TR, et al. All-cause mortality in people with cirrhosis compared with the general population: a population-based cohort study. Liver Int 2012;32:79-84
Pranab M B, Lindsay Y K, Carl L B, Alice P, et al. Need for Pre-transplant Midodrine does not negatively impact simultaneous Liver- Kidney transplant outcomes. Transplant Direct 2021;7:640.
Ng CK, Chan MH, Tai MH, Lam CW. Hepatorenal syndrome. Clin Biochem Rev 2007;28:11-7
Parikh P. Midodrine as a secondary prophylaxis for HRS. Gut 2021;70:68-68.1.
V Singh, Sahdeb P D, Baljinder S, Rajesh V, et al. Midodrine in patients with cirrhosis and refractory or recurrent ascites: A randomized pilot study. J Hepatol 2012;56:348-354.
Carroll LM, Wiedmann M, den Bakker H, Siler J, Warchocki S, Kent D, et al. Whole-genome sequencing of drug-resistant salmonella enterica isolates from dairy cattle and humans in New York and Washington states reveals source and geographic associations. Appl Environ Microbiol 2017;83:00140-17.
- Abstract Viewed: 140 times
- PDF Downloaded: 5 times