Saturday January 19, 2008
Combo for Hepato-renal !!
There is enough literature to support the idea that combo of "octreotide and midodrine" along with "albumin" may improve renal function in hepato-renal syndrome. In this combo, some studies have included TIPS (transjugular intrahepatic portosystemic stent shunt) also. Reports appear to be encouraging atlest in terms of improvement of renal function.
Doses used in the ballpark of midodrine up to 12.5 mg tid, octreotide 20 mg IM once, albumin 150 mg q weekly. But can be increase more frequently in ICU setting, if required.
The idea behind use of this combo is the simple hypothesis that refractory ascites and hepatorenal syndrome are mediated in part by diminished circulatory volume and that treatment with midodrine, octreotide and albumin can improve renal and patient outcomes by restoring effective circulating volume and systemic perfusion.
Also, this combo is under investigation as an alternative to large volume paracentesis !
References: Click to get abstracts / articles
1. Octreotide/Midodrine Therapy Significantly Improves Renal Function and 30-Day Survival in Patients with Type 1 Hepatorenal Syndrome - Digestive Diseases and Sciences, Volume 52, Number 3 / March, 2007
2. The Use of Drugs to Improve Kidney Function in Patients With Liver and Kidney Dysfunction - Clinical trial # NCT00240045, clinicaltrials.gov
3. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome - Hepatology, Volume 40, Issue 1 , Pages 55 - 64
4. Alternatives to Large Volume Paracentesis Study (LVP) - clinical trial # NCT00530959, clinicaltrials.gov