{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T14:01:24Z","timestamp":1773496884772,"version":"3.50.1"},"reference-count":46,"publisher":"American Physiological Society","issue":"2","funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100006356","name":"University of Southern Denmark","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006356","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American Journal of Physiology-Gastrointestinal and Liver Physiology"],"published-print":{"date-parts":[[2020,2,1]]},"abstract":"<jats:p> Acute kidney injury and hepatorenal syndrome (HRS) are frequent complications in patients with cirrhosis and ascites. First-line treatment is terlipressin, which reverses HRS in ~40% of patients but also lowers cardiac output (CO). We aimed to investigate whether reversing the cardio-suppressive effect of terlipressin with the \u03b2-adrenoceptor agonist dobutamine would increase CO and thereby increase the glomerular filtration rate (GFR). We randomized 25 patients with cirrhosis, ascites, and impaired renal function (2:2:1): group A received terlipressin followed by the addition of dobutamine; group B received dobutamine and terlipressin as monotherapies; and group C received placebo. Renal and cardiac functions were assessed during 8 clearance periods of 30 min, and concentrations of vasoactive hormones were measured. Dobutamine as a monotherapy increased CO (1.03 L\/min, P &lt; 0.01) but had no significant effects on GFR. Renin ( P &lt; 0.05), angiotensin II ( P &lt; 0.005), and aldosterone ( P &lt; 0.05) increased after dobutamine infusion. Terlipressin as a monotherapy improved GFR (18.9 mL\u00b7min<jats:sup>\u22121<\/jats:sup>\u00b7m<jats:sup>\u22122<\/jats:sup>, P = 0.005) and mean arterial pressure (MAP) (14 mmHg, P = 0.001) but reduced CO (\u22120.92 L\/min, P &lt; 0.005) and renin ( P &lt; .005). A combined treatment of dobutamine and terlipressin had a positive effect on CO (1.19 L\/min, P &lt; 0.05) and increased renin ( P &lt; 0.005), angiotensin II ( P &lt; 0.005), and aldosterone ( P &lt; 0.05), but it had no significant effects on MAP or GFR. Dobutamine reversed the cardio-suppressive effect of terlipressin in cirrhosis, ascites, and impaired renal function. However, dobutamine reduced peripheral vascular resistance, activated renin-angiotensin-aldosterone system, and did not improve GFR compared with terlipressin as a monotherapy. Therefore, dobutamine cannot be recommended in cirrhosis and ascites. <\/jats:p><jats:p> NEW &amp; NOTEWORTHY This study shows that the cardio-suppressive effects of the vasopressin receptor agonist terlipressin can be reversed by dobutamine. This is a novel observation in patients with decompensated cirrhosis. Furthermore, we show that dobutamine reduced the peripheral vascular resistance and activated the renin-angiotensin system, whereas renal function was not further improved by terlipressin alone. <\/jats:p>","DOI":"10.1152\/ajpgi.00328.2019","type":"journal-article","created":{"date-parts":[[2019,12,16]],"date-time":"2019-12-16T11:45:51Z","timestamp":1576496751000},"page":"G313-G321","source":"Crossref","is-referenced-by-count":14,"title":["Dobutamine reverses the cardio-suppressive effects of terlipressin without improving renal function in cirrhosis and ascites: a randomized controlled trial"],"prefix":"10.1152","volume":"318","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9443-5846","authenticated-orcid":false,"given":"Mads","family":"Israelsen","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark"},{"name":"Department of Clinical Research, University of Southern Denmark, Odense, 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