Influence of Albumin Treatment Duration on Outcome of Terlipressin Therapy in Patients With HRS ‐ AKI

BACKGROUND AND AIMS: Volume expansion with albumin is recommended to establish a diagnosis of hepatorenal syndrome-acute kidney injury (HRS-AKI). The optimal duration of albumin administration is debated and requires balancing the risk of overtreatment with the need for timely diagnosis and treatment. Therefore, this study aimed to compare the impact of different albumin treatment durations on terlipressin response and the prognosis of patients with HRS-AKI treated with terlipressin and albumin. METHODS: This multicenter, retrospective secondary analysis included patients with suspected HRS-AKI who were treated with terlipressin and albumin at 12 German centers. One hundred forty five patients were available for further analysis. The cohort was dichotomized into patients treated with albumin for < 24 h and for 24-60 h before initiation of terlipressin. Patients were followed for treatment response to terlipressin, need for haemodialysis (HD), survival, or liver transplantation (LT). RESULTS: Median MELD score of the cohort was 25 [IQR 21; 31]. During follow-up, 59 patients (40.7%) achieved a complete response to treatment with terlipressin, and 96 patients (66.2%) died or received an LT. Response rates to terlipressin therapy did not differ between albumin treatment groups (< 24 h vs. 24-60 h). In multivariable competing risk models, treatment duration of albumin was not associated with any response to terlipressin, considering death and LT as competing events. Of note, albumin treatment duration did not affect HD-/LT-free survival. CONCLUSION: Extending albumin treatment beyond 24 h had no impact on treatment response to terlipressin and albumin or HD-/LT-free survival in patients with HRS-AKI. CLINICAL TRIAL NUMBER: NCT06161766.