Noradrenaline versus terlipressin in the treatment of hepato-renal syndrome: a randomized study.

Background and Aim: Acute Kidney Injury(AKI) due to Hepato Renal Syndrome(HRS) has a high mortality. Splanchnic Vasoconstriction using agents like Noradrenaline or Terlipressin along with albumin is the recommended treatment. Although routinely used in India, its superiority Noraenaline debatable. Materials methods: We conducted an open labelled randomized trial, which 111 patients HRS-AKI (diagnosed by Ascites club criteria) were assigned computer generated block randomisation 1:1 ratio into Group A receiving (n= 54, 48.6%) group B (n =57, 51.4% ). Additionally, both groups administered Midodrine, starting 48 hours prior randomisation. Primary end point was return of serum creatinine 0.3 mg/dL above baseline value. Secondary points included adverse effects, progression liver transplantation, mortality cost effectiveness. Results: Of patients, 61(55%) responded given treatment demonstrating reversal 33(54.1%) belonged group-A 28 (45.9%) group-B (p =0.205). The total (inclusive ICU admission central line placement) significantly cheaper compared (median (range) INR.7350(5250-7350) vs INR.63000.00(54000-63000, p <0.001). There no difference transplantation between two groups. In whole study group, concomitant hepatic encephalopathy had poor response HRS therapy higher Liver Transplantation performed 29 (15 14 B) 3-month 5.4%(n=6). Conclusion: equally effective as terlipressin, HRS- AKI, when combined Midodrine. than despite need for admission. Patients who managed get transplanted excellent survival.