Chronic Kidney Disease Does Not Influence Response to Terlipressin in Hepatorenal Syndrome–Acute Kidney Injury

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BACKGROUND & AIMS: Efficacy of treatment with terlipressin and its impact on outcome in patients with hepatorenal syndrome-acute kidney injury (HRS-AKI) and chronic kidney disease (CKD) is unknown. This multicenter, retrospective, observational study aimed to investigate treatment response of terlipressin (+ albumin) in patients with HRS-AKI and CKD compared with patients without CKD. METHODS: A total of 395 patients who received albumin/terlipressin were retrospectively analyzed and stratified according to presence of CKD at baseline. The primary endpoint was a complete response to terlipressin treatment. Secondary endpoints included adverse events, need for renal replacement therapy and 12-month liver transplantation-free survival. RESULTS: A total of 37.6% of patients with CKD and 45.6% of patients without CKD (P = .201) had complete treatment response. CKD had no influence on treatment response to terlipressin (subdistribution hazard ratio [sHR], 0.80 [95% confidence interval (CI), 0.58-1.10]; P = .171). Only delta serum creatinine was significantly associated with complete treatment response to terlipressin (sHR, 0.59 [95% CI, 0.47-0.74]; P < .001) without more complications overall (19.8% vs 15.3%; P = .350). However, patients with CKD had more pulmonary edema (5.9% vs 1.7%; P = .036). Mortality (30 days: 32.7% vs 28.6%; P = .450; 1 year: 43.6% vs 41.5%; P = .727) as well as need for renal replacement therapy during follow-up (26.7% vs 22.8%; P = .498) was similar between groups. After adjusting for Model for End-Stage Liver Disease score and treatment response, CKD did not impact survival in patients with HRS-AKI (sHR, 1.08 [95% CI, 0.63-1.72]; P = .759) considering liver transplantation as competing event. CONCLUSIONS: CKD does not adversely affect treatment response to terlipressin or survival in patients with HRS-AKI. CLINICALTRIALS: gov, Number: NCT06161766.