Medical management of hepatorenal syndrome.

Association of APOL1 variants with mild kidney disease in the first-degree relatives of African American patients with non-diabetic end-stage renal disease. et al. Genome-wide association scan for diabetic nephropathy susceptibility genes in type 1 diabetes. Sir, We have read with great interest the manuscript from Davenport et al. [1], concerning the medical management of patients with hepatorenal syndrome. We request the clarification of components in Table 4 which may be labeled incorrectly. The authors reported survival rates from Esrailian et al. [2] as 43% in patients receiving combination octreotide and midodrine therapy versus 71% control group. Based on our review of this trial, we find that the reported values represent mortality rates instead of survival. Given this finding, the survival rates in Table 4 should be modified to 57% in the treatment group versus 29% in the control group which further demonstrates benefit from this combination therapy. On Page 38, Davenport et al. [1] referenced Pomier-Layrargues et al. [3] as having a higher survival rate in patients treated with the midodrine and octreotide combination compared with the combination of dopamine and albumin. Review of this reference reveals a double-blinded crossover comparison of octreotide versus placebo to evaluate the improvement in renal function at 8 days. We suggest that the authors may have intended to credit Angeli et al. [4] with this trial review and summation. Angeli et al. [4] compared the effects of dopamine and the combination of midodrine and octreotide in patients diagnosed with hepatorenal syndrome (HRS) Type 1. Upon our review of this reference, we find that patients in both groups received albumin. We suggest that a more accurate description of this trial in Table 4 might reflect dopamine alone in the comparator group column and 20–40 g/day in the albumin administration column. Table 4 notes a study by Wong et al. [5] correctly as a prospective trial that examines the role of transjugular intrahepa-tic portosystemic stent shunt with background midodrine, octreotide and albumin therapy in HRS Type 1 patients. It was reported in the study by Davenport et al. [1] that reference 72 reflects this citation instead of the noted reference 61, a study of HRS Type 2 patients not included in this table. Further review of Wong et al. [5] reveals that all patients received albumin 50 g/day for 5 days prior to trial initiation and were subsequently continued on albumin 50 g/ day for the …