INFUSE: Rationale and design of a multi-center, open label, collaborative study to treat HRS-AKI with continuous terlipressin infusion

The Application of Terlipressin in the Management of Ascites in Liver Cirrhosis: Current Status and Prospects

Ascites due to liver cirrhosis is a common complication in patients with liver disease, severely affecting their prognosis and quality of life. Traditional treatment methods have significant limitations in managing ascites, highlighting the need for new therapeutic approaches. As an antidiuretic drug, terlipressin has shown good efficacy and potential in treating ascites. This review covers terlipressin's application in managing ascites caused by liver cirrhosis, covering the mechanism of action, usage strategies, clinical effects, and potential side effects. Clinical trial results are discussed to provide a glimpse into the efficacy and safety of terlipressin in managing ascites and its side effects. Additionally, we provide detailed discussions on medication precautions and management strategies for adverse reactions in high-risk patients. Finally, this review outlines future research directions, such as new clinical trial designs, comparisons of terlipressin with other novel drugs, and the exploration of individualized treatment models. These efforts aim to provide references for clinical practice and promote further development in this field.

Terlipressin for hepatorenal syndrome

PURPOSE OF REVIEW

The definition and diagnostic criteria of hepatorenal syndrome-acute kidney injury (HRS-AKI) has undergone recent changes. A major vasoconstrictor, terlipressin, has recently been approved as pharmacotherapy for HRS-AKI in the United States. The purpose of this review is to familiarize the readers with these new diagnostic criteria of HRS-AKI, and how best to use terlipressin.

RECENT FINDINGS

Terlipressin is effective either as bolus dosing or continuous infusion and can achieve reversal of HRS-AKI in approximately 40% of patients. Continuous infusion allows lower daily dose with equal efficacy and less side effects but not an approved mode of administration in the United States. Response to terlipressin in the randomized controlled trials was defined as repeat reduction of serum creatinine to less than 1.5 mg/dl. Newer studies will likely require response to treatment to be defined as a repeat serum creatinine to be less than 0.3 mg/dl from baseline. Terlipressin use is associated with ischemic side effects and potential for respiratory failure development.

SUMMARY

Careful patient selection and close monitoring are necessary for its use. Response to terlipressin with HRS-AKI reversal is associated with improved outcomes with better survival and less requirement for renal replacement therapy.