{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:01Z","timestamp":1791849601103,"version":"4.3.4"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,1,4]],"date-time":"2017-01-04T00:00:00Z","timestamp":1483488000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000360","name":"Scottish Funding Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000360","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hepatorenal syndrome type 1 (<jats:styled-content style=\"fixed-case\">HRS<\/jats:styled-content>1) is a functional, rapidly progressive, potentially reversible form of acute kidney injury occurring in patients with cirrhosis. Characterised by intense renal arterial vasoconstriction, it carries a very poor prognosis. There is a significant unmet need for a widely approved, safe and effective pharmacological treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To re\u2010evaluate efficacy and safety of pharmacological treatments for <jats:styled-content style=\"fixed-case\">HRS<\/jats:styled-content>1, in the light of recently published randomised controlled trials (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content> (Ovid<jats:styled-content style=\"fixed-case\">SP<\/jats:styled-content>), <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content>, PubMed and Cochrane registers were searched for <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s reporting efficacy and adverse events related to pharmacological treatment of <jats:styled-content style=\"fixed-case\">HRS<\/jats:styled-content>1. Search terms included: \u2018hepatorenal syndrome\u2019, \u2018terlipressin\u2019, \u2018noradrenaline\u2019, \u2018octreotide\u2019, \u2018midodrine\u2019, \u2018vasopressin\u2019, \u2018dopamine\u2019, \u2018albumin\u2019 and synonyms. Comparison of vasoactive drugs vs. placebo\/no treatment, and two active drugs were included. Meta\u2010analysis was performed for <jats:styled-content style=\"fixed-case\">HRS<\/jats:styled-content>1 reversal, creatinine improvement, mortality and adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twelve <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s enrolling 700 HRS1 patients were included. Treatment with terlipressin and albumin led to <jats:styled-content style=\"fixed-case\">HRS<\/jats:styled-content>1 reversal more frequently than albumin alone or placebo (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>: 2.54, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.51\u20134.26). Noradrenaline was effective in reversing <jats:styled-content style=\"fixed-case\">HRS<\/jats:styled-content>1, but trials were small and nonblinded. Overall, there was mortality benefit with terlipressin (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>: 0.79, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.63\u20131.01), but sensitivity analysis including only trials with low risk of selection bias weakened this relationship (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>: 0.87, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.71\u20131.06). Notably, there was a significant risk of adverse events with terlipressin therapy (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>: 4.32, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.75\u201324.86).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Terlipressin treatment is superior to placebo for achieving <jats:styled-content style=\"fixed-case\">HRS<\/jats:styled-content>1 reversal, but mortality benefit is less clear. Terlipressin is associated with significant adverse events, but infusion regimens may be better tolerated. There is continued need for safe and effective treatment options for hepatorenal syndrome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.13912","type":"journal-article","created":{"date-parts":[[2017,1,4]],"date-time":"2017-01-04T05:56:38Z","timestamp":1483509398000},"page":"593-603","source":"Crossref","is-referenced-by-count":56,"title":["Systematic review with meta\u2010analysis: vasoactive drugs for the treatment of hepatorenal syndrome type 1"],"prefix":"10.1111","volume":"45","author":[{"given":"F. J.","family":"Gifford","sequence":"first","affiliation":[{"name":"Department of Hepatology Royal Infirmary of Edinburgh Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. R.","family":"Morling","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Public Health School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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