Physiologic derangements leading to hepatorenal syndrome and effects of terlipressin.
Figure 1 from Velez et al, AJKD © National Kidney Foundation.

Hepatorenal syndrome (HRS) is a form of acute kidney injury (AKI) occurring in patients with advanced cirrhosis and is associated with significant morbidity and mortality. There are no approved treatments for HRS in the United States, but multiple countries, including much of Europe, use terlipressin, a synthetic vasopressin analogue, as a first-line therapy. In a recent Perspective published in AJKD, Justin Belcher and colleagues explore the history of regulatory approval for terlipressin in the United States, examine the results from CONFIRM (A Multi-Center, Randomized, Placebo Controlled, Double-Blind Study to Confirm Efficacy and Safety of Terlipressin in Subjects With Hepatorenal Syndrome Type 1) and the concerns they raised, and consider the future role of terlipressin in this critical clinical area of continued unmet need.

AJKDBlog’s Interviews Editor, Timothy Yau @Maximal_Change recently sat down to discuss these issues with Dr. Belcher @jmbnephdoc and Juan Carlos Velez @VelezNephHepato.

If the embedded player above doesn’t work, please click here to watch the video interview. Special thanks to Drs. Belcher and Velez for agreeing to do the interview!

To view this Perspective, please visit AJKD.org.

Title: Terlipressin and the Treatment of Hepatorenal Syndrome: How the CONFIRM Trial Moves the Story Forward
Author: Justin M. Belcher, Xavier Vela Parada, Douglas A. Simonetto, Luis A. Juncos, Nithin Karakala, Hani M. Wadei, Pratima Sharma, Kevin R. Regner, Mitra K. Nadim, Guadalupe Garcia-Tsao, Juan Carlos Q. Velez, Samir M. Parikh, Raymond T. Chung, and Andrew S. Allegretti, on behalf of the HRS-HARMONY Study Investigators
DOI: 10.1053/j.ajkd.2021.08.016