{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:31:07Z","timestamp":1786480267722,"version":"build-2736575974"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T00:00:00Z","timestamp":1675987200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2023,4]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Raising the mean arterial pressure (MAP) during management of hepatorenal syndrome type 1 (HRS-1) is associated with improvement in kidney function, independently of baseline MAP or model for end-stage liver disease.<\/jats:p>\n <\/jats:list-item>\n \n Raising the MAP by 15 mm Hg or greater leads to greater reduction in serum creatinine in HRS-1.<\/jats:p>\n <\/jats:list-item>\n \n Norepinephrine use confers greater probability of improvement in kidney function in HRS-1 compared with midodrine\/octreotide.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Raising mean arterial pressure (MAP) during treatment of hepatorenal syndrome type 1 (HRS-1) with vasoconstrictors (VCs) is associated with renal recovery. However, the optimal MAP target and factors associated with response to VCs remain unclear.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Records from hospitalized patients with HRS-1 treated with VCs without shock were reviewed searching for those who achieved \u22655 mm Hg rise in MAP within 48 hours. We examined the relationship between the mean MAP achieved during the first 48\u201372 hours of VC therapy and the change in serum creatinine (sCr) up to day 14. Endpoints were >30% reduction in sCr without need for dialysis or death by day 14 (primary) or by day 30 (secondary).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Seventy-seven patients with HRS-1 treated for 2\u201310 days with either norepinephrine (\n n<\/jats:italic>\n =49) or midodrine\/octreotide (\n n<\/jats:italic>\n =28) were included. The median age was 52 years (interquartile range [IQR], 46\u201360), 40% were female, and 48% had alcoholic cirrhosis. At VC initiation, median MAP was 70 mm Hg (IQR, 66\u201373), and median sCr was 3.8 mg\/dl (IQR, 2.6\u20134.9). When analyzed by tertiles of mean MAP increment (5\u20139, 10\u201314, \u226515 mm Hg), there was greater reduction in sCr with greater rise in MAP (ANOVA for trend,\n P<\/jats:italic>\n < 0.0001). By multivariate logistic regression analysis, mean MAP rise during the first 48\u201372 hours (odds ratio [OR], 1.15 [1.02 to 1.299],\n P<\/jats:italic>\n =0.025), norepinephrine as VC (OR, 5.46 [1.36 to 21.86],\n P<\/jats:italic>\n =0.017), and baseline sCr [OR, 0.63 [0.41 to 0.97],\n P<\/jats:italic>\n =0.034) were associated with the primary endpoint, whereas mean MAP rise during the first 48\u201372 hours (OR, 1.17 [1.04 to 1.33],\n P<\/jats:italic>\n =0.012) and baseline sCr (OR, 0.63 [0.39 to 0.98],\n P<\/jats:italic>\n =0.043) were associated with the secondary endpoint.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Greater magnitude of rise in MAP with VC therapy in HRS-1, lower baseline sCr, and use of norepinephrine over midodrine\/octreotide are associated with kidney recovery. Targeting an increment of MAP \u226515 mm Hg may lead to favorable renal outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000000000000068","type":"journal-article","created":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T14:12:27Z","timestamp":1676038347000},"page":"e448-e456","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":15,"title":["Responsiveness to Vasoconstrictor Therapy in Hepatorenal Syndrome Type 1"],"prefix":"10.34067","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9670-1095","authenticated-orcid":false,"given":"Juan Carlos Q.","family":"Velez","sequence":"first","affiliation":[{"name":"Department of Nephrology, Ochsner Health, New Orleans, Louisiana"},{"name":"Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia"},{"name":"HRS-HARMONY Consortium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9766-7968","authenticated-orcid":false,"given":"Nithin","family":"Karakala","sequence":"additional","affiliation":[{"name":"HRS-HARMONY Consortium"},{"name":"Division of Nephrology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasra","family":"Tayebi","sequence":"additional","affiliation":[{"name":"Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrance J.","family":"Wickman","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Ochsner Health, New Orleans, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muner M. B.","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Ochsner Health, New Orleans, Louisiana"},{"name":"Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary A.","family":"Kovacic","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Ochsner Health, New Orleans, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6113-4972","authenticated-orcid":false,"given":"George","family":"Therapondos","sequence":"additional","affiliation":[{"name":"Multiorgan Transplant Institute, Ochsner Health, New Orleans, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7190-6665","authenticated-orcid":false,"given":"Swetha R.","family":"Kanduri","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Ochsner Health, New Orleans, Louisiana"},{"name":"Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9416-6623","authenticated-orcid":false,"given":"Andrew S.","family":"Allegretti","sequence":"additional","affiliation":[{"name":"HRS-HARMONY Consortium"},{"name":"Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4599-8850","authenticated-orcid":false,"given":"Justin M.","family":"Belcher","sequence":"additional","affiliation":[{"name":"HRS-HARMONY Consortium"},{"name":"Division of Nephrology, Department of Medicine, Yale University, New Haven, Connecticut"},{"name":"Veterans Affairs Connecticut Healthcare, West Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4133-1784","authenticated-orcid":false,"given":"Kevin R.","family":"Regner","sequence":"additional","affiliation":[{"name":"HRS-HARMONY Consortium"},{"name":"Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathy","family":"Wentowski","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Ochsner Health, New Orleans, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,2,10]]},"reference":[{"issue":"3","key":"B1-20250823","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1038\/s41581-019-0218-4","article-title":"Reappraising the spectrum of AKI and hepatorenal syndrome in patients with 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