Kidney Week Educational Symposia-Hepatorenal Syndrome Type 1: Advances in Management

Video Transcription

Video Summary

The symposium reviews recent advances in managing hepatorenal syndrome–associated acute kidney injury (HRS-AKI, formerly HRS type 1), focusing on volume management and vasoconstrictor therapy. AKI is increasingly common in hospitalized cirrhotic patients, especially with infection, and modern definitions mirror KDIGO criteria. Because causes overlap (prerenal, HRS, ATN, congestion), accurate phenotyping is critical.<br /><br />The first talk emphasizes that albumin-based volume expansion is central to diagnosis and treatment but can be harmful when patients are already fluid replete. Trials such as ATTIRE found no benefit to targeting higher serum albumin, while showing more pulmonary edema/fluid overload. CONFIRM (terlipressin plus albumin) improved renal recovery but had higher respiratory failure, raising concern that protocol-driven volume strategies and poor volume assessment contribute to adverse events. Clinical exam and CVP are unreliable; point-of-care ultrasound (IVC, cardiac output measures, passive leg raise, lung ultrasound) may guide individualized strategies, including identifying intra-abdominal hypertension where paracentesis can improve renal function.<br /><br />The second talk reviews HRS pathophysiology (splanchnic vasodilation, renal vasoconstriction, inflammation) and compares vasoconstrictors. Terlipressin has the strongest RCT evidence and outperforms midodrine/octreotide, with similar efficacy to norepinephrine (though norepinephrine often requires ICU/central access). Response correlates with achieving a MAP rise ~10 mmHg and with lower baseline creatinine and less severe liver failure, while careful monitoring for adverse effects and volume overload is essential.

Asset Subtitle

Moderators: Mitra Nadim

Speakers:

Introduction - Mitra Nadim
Volume Management in Cirrhosis-Associated AKI: Avoiding Iatrogenic Volume Overload - Nithin Karakala
Comparison of Vasoconstrictors in Cirrhosis-Associated AKI - Kevin Regner

Meta Tag

Date 11/5/2021

Pathway 1 Acute Kidney Injury

Session ID 408687

Session Type ES - Educational Symposium

Keywords

hepatorenal syndrome

HRS-AKI

cirrhosis acute kidney injury

albumin volume expansion

fluid overload pulmonary edema

point-of-care ultrasound

terlipressin

norepinephrine

mean arterial pressure target