{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T10:13:10Z","timestamp":1780481590146,"version":"3.54.1"},"reference-count":20,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T00:00:00Z","timestamp":1757808000000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014468","name":"Mallinckrodt Pharmaceuticals","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014468","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Treatments for hepatorenal syndrome with acute kidney injury (HRS\u2010AKI) that are not FDA\u2010approved have been widely used in the United States (US) with variable outcomes. This study describes the practice patterns, outcomes, and healthcare utilization around vasopressor use before terlipressin approval in 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective chart review study was conducted at 10 US medical centers, assessing adult patients diagnosed with HRS\u2010AKI between 2016 and 2019. The primary outcome was treatment response (change in serum creatinine [SCr] from the day of vasopressor treatment initiation to Day 14\/vasopressor discontinuation). Secondary outcomes included overall and transplant\u2010free survival, treatment patterns, and healthcare resource use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 198 eligible patients, 129 and 69 had mild\/moderate (SCr\u2009&lt;\u20095 mg\/dL, acute\u2010on\u2010chronic liver failure [ACLF]\u2009\u2264\u20092) and severe disease (SCr\u2009\u2265\u20095 mg\/dL, ACLF\u2009&gt;\u20092), respectively. The mean age was 57\u2009years; 52.5% were males, and 71.2% were White. Alcohol\u2010associated cirrhosis (53.5%) was the most common cause of cirrhosis. All 198 patients had a physician\u2010diagnosed HRS\u2010AKI, and only 30.3% met all International Club of Ascites (ICA)\u2010HRS criteria. Most patients (85.4%) initiated treatment with midodrine and octreotide for a median of 7\u2009days. The overall response rate (<jats:italic>n<\/jats:italic>\u2009=\u2009157) was 20.3%. Median (95% CI) overall and transplant\u2010free survival from vasopressor initiation was 48 (32\u201381) and 28 (19\u201336) days. Notably, 33.8% of patients died during hospitalization, and 31.3% required renal replacement therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Before 2022, hospitalized HRS\u2010AKI patients experienced suboptimal treatment response with off\u2010label treatments and poor survival. There remains an unmet need for safe and effective non\u2010transplant treatments for hospitalized HRS\u2010AKI patients in the United States.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.70255","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T04:50:04Z","timestamp":1757911804000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Challenges in the Treatment of Hepatorenal Syndrome\u2013Acute Kidney Injury: A US Chart Review of Treatment Patterns and Survival Outcomes"],"prefix":"10.1002","volume":"9","author":[{"given":"Arun J.","family":"Sanyal","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Virginia Commonwealth University School of Medicine  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Rajender","family":"Reddy","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Perelman School of Medicine, University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly A.","family":"Brown","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Henry Ford Health System  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles S.","family":"Landis","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Washington Medical Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2935-0245","authenticated-orcid":false,"given":"Giuseppe","family":"Cullaro","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyue","family":"Huang","sequence":"additional","affiliation":[{"name":"Mallinckrodt Pharmaceuticals  Hampton New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4262-3040","authenticated-orcid":false,"given":"Sneha S.","family":"Kelkar","sequence":"additional","affiliation":[{"name":"OPEN Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rutika","family":"Raina","sequence":"additional","affiliation":[{"name":"OPEN Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelby","family":"Corman","sequence":"additional","affiliation":[{"name":"OPEN Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nehemiah","family":"Kebede","sequence":"additional","affiliation":[{"name":"OPEN Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Edmundson","sequence":"additional","affiliation":[{"name":"OPEN Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khurram","family":"Jamil","sequence":"additional","affiliation":[{"name":"Mallinckrodt Pharmaceuticals  Hampton New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew S.","family":"Allegretti","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,14]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2215289"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.12.029"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/egastro-2023-100009"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31884"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22605"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.26072"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2021.1998595"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2019.1580201"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.07.010"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/03007995.2017.1331211"},{"issue":"9","key":"e_1_2_8_12_1","first-page":"1310","article-title":"Diagnosis, Prevention and Treatment of Hepatorenal Syndrome in Cirrhosis","volume":"56","author":"Salerno F.","year":"2007","journal-title":"Gut"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.07.002"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2008290"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0296690"},{"key":"e_1_2_8_16_1","unstructured":"R.Wong K. R.Patidar A.Sidney Barritt et\u00a0al. \u201cReal\u2010World Treatment and Outcomes in Hospitalized Patients With Hepatorenal Syndrome\u2010Acute Kidney Injury and Alcohol\u2010Associated Liver Disease \u201dDigestive Disease Week (DDW) 2025 San Diego CA USA May 3\u20136 2025."},{"key":"e_1_2_8_17_1","unstructured":"S. A.Gonzalez A. S.Allegretti V. V.Chirikov et\u00a0al. \u201cA Comparative Analysis of Real\u2010World HRS\u2010AKI Treatment and Outcomes in the UK and US: Raw Clinical Data and Propensity Score\u2010Matched Evidence \u201dDigestive Disease Week (DDW) 2025 San Diego CA May 3\u20136 2025."},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/CLD.0000000000000086"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.14309\/01.ajg.0001037196.10589.36"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0000000000001700"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.curtheres.2022.100663"}],"container-title":["JGH Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgh3.70255","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T08:56:12Z","timestamp":1760691372000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jgh3.70255"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":20,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1002\/jgh3.70255"],"URL":"https:\/\/doi.org\/10.1002\/jgh3.70255","archive":["Portico"],"relation":{},"ISSN":["2397-9070","2397-9070"],"issn-type":[{"value":"2397-9070","type":"print"},{"value":"2397-9070","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"2025-04-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70255"}}