去甲肾上腺素或特利加压素联合白蛋白治疗1型肝肾综合征效果及安全性比较的Meta分析

目的对去甲肾上腺素、特利加压素联合白蛋白治疗1型肝肾综合征(HRS1)的效果及安全性进行系统评价。方法通过检索PubMed、EMBASE、Medline、Cochrane Library、中国知网、万方和维普等国内外数据库有关去甲肾上腺素或特利加压素联合白蛋白治疗HRS1对比研究的文献。对文献进行质量评价。提取HRS逆转率、病死率、不良事件发生率、平均动脉压、肾功能等指标,应用Review Manager 5. 3软件进行数据分析,各研究间的异质性采用χ2检验判断。二分类变量采用比值比(OR)分析,连续性变量采用加权均数差(WMD)分析,两类变量均计算95%可信区间(95%CI)。结果纳入符合标准的随机对照试验6篇,总样本量298例,其中去甲肾上腺素联合白蛋白和特利加压素联合白蛋白组各149例。Meta分析显示两组的HRS逆转率(OR=0. 95,95%CI:0. 60～1. 49,P=0. 81)、病死率(OR=0. 84,95%CI:0. 51～1. 41,P=0. 51)、不良事件发生率(OR=0. 42,95%CI:0. 16～1. 07,P=0. 07)、平均动脉压(SMD=0. 05,95%CI:-0. 92～1. 03,P=0. 92)、肾功能等指标并无明显差异。结论去甲肾上腺素联合白蛋白与特利加压素联合白蛋白治疗HRS1临床效果及安全性一致,临床上需要时可考虑使用去甲肾上腺素替代特利加压素。     

去甲肾上腺素与特利加压素治疗肝肾综合征疗效比较的Meta分析

目的比较去甲肾上腺素和特利加压素治疗肝肾综合征(HRS)的有效性及安全性。方法检索Pubmed、Medline Embase、Cochrane图书馆,CNKI及万方数据库,获取比较去甲肾上腺素和特利加压素治疗HRS疗效的随机对照试验,检索时间截止至2016年10月,由两名评价员独立提取数据并评估结果和偏倚风险,评价指标包括血清肌酐下降程度、HRS缓解率和不良反应。结果共纳入7篇研究,261例HRS患者,与特利加压素相比,去甲肾上腺素治疗HRS后血清肌酐下降程度差异无统计学意义(MD:-0.06 mg/dL;95%CI:-0.18~0.05;P=0.29);HRS缓解率差异无统计学意义(OR:0.84;95%CI:0.49~1.42;P=0.51);与特利加压素相比,去甲肾上腺素治疗HRS后发生的不良反应更少,差异有统计学意义(OR:0.36;95%CI:0.18~0.73;P=0.005)。结论去甲肾上腺素治疗HRS同样安全有效,去甲肾上腺素能否替代特利加压素治疗HRS仍有待大规模、多中心的随机对照试验进一步证实。     

特利加压素联合白蛋白比较米多君和奥曲肽联合白蛋白治疗肝肾综合征:一项随机试验

<正>肝肾综合征(HRS)是肝硬化的严重并发症,未经治疗其病死率较高。特利加压素联合白蛋白可有效地逆转HRS,由于特利加压素在美国未获批准,因此米多君和奥曲肽联合白蛋白作为一种替代治疗用于HRS。为了比较特利加压素联合白蛋白与米多君和奥曲肽联合白蛋白治疗HRS的疗效,Cavallin等进行了一项随机对照试验。随机分配27例患者接受特利加压素联合白蛋白治疗(TERLI组),22例患者接受米多君和奥曲肽联合白蛋白治疗(MID/OCT组)。TERLI组给予静脉滴注特利加压素,起始剂量为3 mg/24 h,如无应答则逐步     

特利加压素治疗肝肾综合征有效性及安全性的Meta分析

目的 评价特利加压素治疗肝肾综合征(HRS)的有效性及安全性.方法 采用Cochrane系统评价方法,计算机检索MEDLINE,PubMed,Embase,Medline,Cochrane Library及Google(TM)Scholar databases,检索时间截止至2012年4月公开发表的随机对照临床试验.根据纳入与排除标准筛选文献、评价文献质量、提取资料,采用RevMan 5.1软件进行Meta分析.结果 在47篇文献中纳入4篇文献,包括了234例HRS患者.文献的Cochrane质量评价均为B级,均属于较高质量文献.Meta分析结果显示,特利加压素治疗HRS的有效率为47％,明显高于对照组的11.9％(P＜0.00001).结论 特利加压素可显著提高HRS患者肾小球滤过率,降低肌酐水平,改善肾脏功能.     

特利加压素治疗Ⅱ型肝肾综合征的临床疗效观察

目的：观察国产特利加压素治疗Ⅱ型肝肾综合征（HRS）的疗效。方法选取2011年11月－2014年6月上海市浦东新区南华医院收治的25例Ⅱ型 HRS 患者作为治疗组,2011年前用多巴胺治疗的28例Ⅱ型 HRS 患者作为对照组。治疗组随机分成两组,其中一组（12例）每8 h 给药1次,另一组（13例）每12 h 给药1次。两组给药前均予以白蛋白（Alb）扩容,疗程均为7 d。观察两组患者治疗前后症状改善情况,尿素氮、血清肌酐、电解质、尿量、肝功能变化及腹水消退情况。计数资料组间比较采用χ2检验,计量资料组间比较采用 t 检验。结果对照组患者症状改善不明显,治疗组患者症状均得到不同程度的改善。两组患者治疗前后肝功能、血清钠均无明显变化。治疗组患者腹水从大量减为中等量的病例数明显多于对照组,两组比较差异有统计学意义（χ2＝5．705,P ＜0．05）。对照组多巴胺治疗后尿素氮、血肌酐与治疗前比较,有一定程度的改善,但差异无统计学意义（P 值均＞0．05）,尿量治疗前后比较差异有统计学意义（t ＝15．534,P ＜0．01）。治疗组用特利加压素治疗前后尿素氮、血肌酐、尿量比较,差异均具有统计学意义（t 值分别为11．535、9．941、19．685,P 值均＜0．01）;两组治疗后比较尿素氮、血肌酐、尿量变化,差异均具有统计学意义（t 值分别为7．317、9．284、9．839,P 值均＜0．01）。治疗组特利加压素每8 h 给药1次比每12 h 给药1次尿素氮、血肌酐、尿量改善更明显,但治疗后两组比较差异均无统计学意义（P 值均＞0．05）。特利加压素不良反应轻微,患者基本能耐受。结论国产特利加压素联合 Alb 治疗Ⅱ型 HRS 疗效明显,不良反应小,值得临床推广。     

特利加压素对1型肝肾综合征的治疗疗效:一项系统评价及meta分析

目的评价特利加压素治疗1型肝肾综合征的安全性和有效性。方法检索PubMed、Embase等数据库特利加压素治疗1型肝肾综合征有关的随机对照试验;2名研究者独立地对文献进行筛选、质量评价和数据提取,并用RevMan 5.3软件进行安全性和有效性分析。结果研究共纳入13项随机对照试验,共746例患者,试验组均为特利加压素治疗组;对照组包括5项安慰剂、6项去甲肾上腺素、1项多巴胺和1项奥曲肽治疗。总的肝肾综合征缓解为33.7%,死亡率60.1%,meta分析显示特利加压素治疗比对照组更能提高肝肾综合征缓解率(RR=2.13,95%CI:1.26~3.61,P=0.005,I2=51%);但同时伴有更多的不良反应(RR=2.05,95%CI:1.36~3.09,P=0.0006,I2=0%)。亚组分析显示特利加压素比安慰剂对治疗肝肾综合征具有优势;但其疗效和安全性与去甲肾上腺素比较差异无统计学意义。结论特利加压素是治疗1型肝肾综合征患者有效的药物之一。     

特利加压素联合大剂量白蛋白治疗老年肝肾综合征患者的疗效及安全性观察

目的 观察特利加压素联合大剂量白蛋白治疗老年肝肾综合征患者的疗效及安全性. 方法 30例患者随机分为对照组(13例)和试验组(17例).在内科综合治疗基础上,对照组予小剂量多巴胺联合大剂量白蛋白治疗;试验组使用特利加压素联合大剂量白蛋白,均连续使用7～14 d.观察患者临床症状、尿量、血肌酐、尿素氮、腹水消长情况、不良反应、终止治疗事件及治疗后的转归. 结果 试验组患者与治疗前相比,治疗1d后尿量明显增加(P＜0.01),血肌酐、尿素氮水平明显下降(P＜0.05).治疗第7天后比第3天后尿量进一步增加,血肌酐、尿素氮进一步降低(P＜0.05).同时患者腹水亦有所消退.而对照组患者治疗前后尿量、血肌酐及尿素氮水平无明显变化(P＞0.05). 结论 特利加压素联合大剂量白蛋白能有效治疗肝肾综合征,为老年肝肾综合征患者提供了一条安全有效的治疗途径.     

特利加压素治疗肝肾综合征疗效分析及不良反应研究

目的观察特利加压素治疗肝肾综合征（HRS）的近远期疗效及不良反应。方法将42例患者随机分为两组：A 组22例为基础治疗联合特利加压素;B 组20例为基础治疗。观察治疗期间患者临床症状、尿量、肌酐、平均动脉压及血钠等指标。结果与 B 组比较,A 组患者治疗后临床症状明显改善,尿量增加（P ＜0．01）,平均动脉压上升（P ＜0．01）,血肌酐值下降（P ＜0．01）,但两种治疗方案对血钠的影响差异无统计学意义（P ＞0．05）。A 组出现相关不良反应（房性期前收缩、痉挛性腹痛、水样泻等）,而 B 组无明显不良反应发生。A 组患者生存期较 B 组明显延长（P ＜0．05）,特别是Ⅱ型 HRS 患者的生存期延长更明显（P ＜0．01）。结论特利加压素治疗HRS 有明显的疗效优势,同时也有一定的不良反应,但通常发生的不良反应较为轻微,并且能较明显改善 HRS 患者的生存期。     

肌酐、平均动脉压对Ⅱ型肝肾综合征治疗应答的早期预测价值

目的 特利加压素联合白蛋白治疗仅对部分Ⅱ型肝肾综合征（HRS）患者有效,筛选出对治疗有应答的Ⅱ型HRS的早期预测因子,为预测Ⅱ型HRS的治疗预后提供有效的手段.方法 37例被明确诊断为Ⅱ型HRS的患者予以特利加压素联合白蛋白治疗,疗程为血肌酐降至133μmoL/L以下或最长疗程14天,观察患者治疗前、中、后实验室指标（肝功能、血肌酐、凝血功能、电解质等）、临床表现（平均动脉压、尿量）,并进行统计学分析.结果 单变量分析显示,两组患者治疗前血肌酐水平、总胆红素、肾小球滤过率、终末期肝病模型（MELD）评分对疗效有预测意义,多因素分析显示仅治疗前肌酐水平对疗效有预测意义,构建肌酐的ROC曲线,AUC为0.855,最佳临界值151.5.μmol/L,灵敏度为76.0％,特异度为91.7％.12例对治疗有应答的患者,治疗的第3天起平均动脉压升高,与无应答组患者比较,差异有统计学意义（P＜0.05）.结论 治疗前监测血清基线肌酐值、早期平均动脉压对于特利加压素联合白蛋白治疗Ⅱ型HRS应答的预测具有较好的临床价值.     

血管加压素在肝肾综合征治疗中的应用

内脏血管扩张是肝肾综合征(HRS)发病的始动环节,血管加压素治疗HRS的机制是抑制内脏血管扩张。鸟氨酸血管加压素尽管其疗效确切,但因较多的严重不良反应限制了其临床应用。特利加压素为治疗HRS的首选。血胆红素水平、Child-Pugh评分、血清钠水平是对特利加压素良好反应的预测指标,特利加压素具有不依赖肝功能而独立改善肾功能的作用。     

Reversal of hepatorenal syndrome in cirrhotic patients with terlipressin plus albumin. First experience in Mexico

Introduction. Type 1 hepatorenal syndrome (HRS) is a functional renal failure that complicates end-stage cirrhosis. The vasopressin analogue terlipressin has been associated with improved renal function in patients with type 1 HRS.Aim. To evaluate the effectiveness of an infusion of terlipressin plus albumin in reversing type 1 HRS, its tolerability, and its adverse effects.Methods. Thirteen consecutive patients with cirrhosis and type 1 HRS were included in the study. All patients received terlipressin plus albumin as treatment for HRS. The patients were divided in two groups. Group 1 contained eight patients in whom HRS was reversed with treatment, who were classified as responders. Group 2 contained five patients who were nonresponders.Results.Sixty-one percent of the patients who received terlipressin plus albumin responded to therapy and underwent HRS reversal. In two patients, treatment with terlipressin was stopped because of adverse events. No relapse of HRS after terlipressin withdrawal was observed in this study.Conclusion.The rate of successful treatment with terlipressin plus albumin was 61%, similar to that in previously reported controlled trials. However, this is the first experience reported in Mexico. A cardiovascular evaluation is required before the start of treatment with terlipressin. This treatment appears to be an effective therapy for improving renal function in patients with type 1 HRS.     

The use of vasoconstrictors in patients with cirrhosis: type 1 HRS and beyond

In patients with cirrhosis and type 1 hepatorenal syndrome (HRS), systemic vasodilation, which is mainly attributable to splanchnic vasodilation, plays a critical role in the activation of endogenous vasoconstrictor systems, resulting in renal vasoconstriction and functional renal failure. It has been suggested that the use of splanchnic (and systemic) vasoconstrictors such as terlipressin (a vasopressin analog) or alpha-1-adrenoceptor agonists (midodrine or noradrenaline) may improve renal function in patients with type 1 HRS. Six studies (with only one randomized study in a small series of patients) have shown that terlipressin improves renal function in these patients. However, there is evidence that terlipressin alone may be less effective than terlipressin combined with intravenous albumin in improving renal function. Future randomized studies should confirm this difference and evaluate the impact of terlipressin therapy (with or without intravenous albumin) on survival. Interestingly, in nonrandomized studies, the use of alpha-1 agonists combined with other therapies (octreotide and albumin for midodrine; furosemide and albumin for noradrenaline) has been shown to improve renal function in patients with type 1 HRS. The efficacy and safety of combined therapies including alpha-1 agonists should be confirmed in randomized studies. Finally, preliminary evidence suggests that vasoconstrictor administration may be a novel therapeutic approach targeting vasodilation involved in the mechanism of: (1) renal failure in type 2 HRS; (2) paracentesis-induced circulatory dysfunction; and (3) arterial hypotension induced by byproducts of gram-negative bacteria. Further studies are needed in all these fields.     

Terlipressin and Albumin in Patients with Cirrhosis and Type I Hepatorenal Syndrome

Purpose: Hepatorenal syndrome (HRS) is a pre-renal-like dysfunction that generally onsets in cirrhotic patients presenting ascites. We investigated the improvement of renal function in subjects with hepatorenal syndrome after terlipressin administration and the survival times after this treatment. Fifty-two patients affected by cirrhosis, with diagnosis of hepatorenal syndrome were treated with intravenous terlipressin plus albumin (group A) or with albumin alone (group B). Liver and renal function, plasma renin activity, and aldosterone plasma levels were monitored. Results: Patients from group A showed a significant improvement (p < 0.001) of renal function valued by creatinine rate compared with the results obtained in group B. The probability of survival was higher in the group A (p < 0.0001). Conclusions: Our results seem to confirm that the administration of terlipressin plus albumin improves renal function in patients with cirrhosis and type I HRS and that a reversal of hepatorenal syndrome is strongly associated with improved survival.     

Clinical course,predictive factors and prognosis in patients with cirrhosis and type 1 hepatorenal syndrome treated with Terlipressin: a retrospective analysis

BACKGROUND AND AIM: Terlipressin has been proposed to treat renal failure in patients with type 1 hepatorenal syndrome (HRS). However, the predictive factors for improved renal function and survival are unknown in patients with type 1 HRS treated with terlipressin. The aim of the present retrospective study was to investigate the predictive factors and prognosis of patients with type 1 HRS treated with terlipressin. METHODS: The clinical charts of 18 consecutive patients with cirrhosis and type 1 HRS treated with terlipressin were studied. The predictive factors for improved renal function and survival were identified using univariate analyses. RESULTS: Improved renal function, indicated by a significant decrease in serum creatinine (61 +/- 4%), occurred in 11 (60%) patients. The only predictive factor for improved renal function was a Child-Pugh's score < or =13 at the time of diagnosis of HRS (P = 0.02). Fifteen patients (83%) died at 45 days and the median survival was 24 days. Of the three patients who survived, two underwent successful orthotopic liver transplantation. Three predictive factors for survival were identified: absence of a precipitating factor for HRS (P = 0.012); improved renal function during terlipressin therapy (P = 0.05); and a dose of terlipressin > or =3 mg/day (P = 0.04). CONCLUSIONS: In patients with type 1 HRS treated with terlipressin, patients with improved renal function had less severe cirrhosis (Child-Pugh >10 but < or =13) than patients without. The predictive factors for survival were the absence of a precipitating factor for HRS, the terlipressin-induced improvement in renal function and a dose of terlipressin of at least 3 mg/day. These findings suggest that a randomized controlled trial investigating the effect of terlipressin on survival in patients with type 1 HRS should be performed.     

Noradrenalin vs terlipressin in patients with hepatorenal syndrome: a prospective, randomized, unblinded, pilot study

BACKGROUND/AIMS: Treatment of hepatorenal syndrome (HRS) is based on vasoconstrictors. Terlipressin is the one with the soundest evidence. Noradrenalin has been suggested as an effective alternative. The current study was aimed at assessing the efficacy and safety of noradrenalin vs terlipressin in patients with HRS. METHODS: Twenty-two consecutive cirrhotic patients with HRS (9 with HRS type 1; 13 with HRS type 2) were included. Patients were randomly assigned to be treated with noradrenalin (0.1-0.7 microg/kg/min) and albumin (10 patients) or with terlipressin (1-2 mg/4h) and albumin (12 patients). Treatment was administered until HRS reversal or for a maximum of two weeks. Patients were followed-up until liver transplantation or death. RESULTS: Reversal of HRS was observed in 7 of the 10 patients (70%) treated with noradrenalin and in 10 of the 12 patients (83%) treated with terlipressin, p=ns. Treatment led in both groups to a significant improvement in renal and circulatory function. No patient developed signs of myocardial ischemia. CONCLUSIONS: Data from this unblinded, pilot study suggest that noradrenalin is as effective and safe as terlipressin in patients with HRS. These results would support the use of noradrenalin, a cheap and widely available drug, in the management of these patients.     

Beneficial effects of terlipressin in hepatorenal syndrome: a prospective,randomized placebo-controlled clinical trial

BACKGROUND AND AIM: Hepatorenal syndrome (HRS) occurs in about 18% of cirrhotic patients with ascites and is characterized by intense renal vasoconstriction, low glomerular filtration rate and preserved tubular function and normal renal histology. The aim of the present study was to examine the effects of terlipressin on renal function, systemic hemodynamics and clinical outcome in patients with HRS. METHODS: The study was a randomized controlled single-blind trial. We randomly assigned 24 consecutive patients with HRS to treatment with terlipressin 1 mg i.v. at 12-h intervals (group A; n = 12) or placebo at 12-h intervals (group B; n = 12). The end-point of the study was improvement in renal functions defined as reversal of HRS and survival at 15 days. RESULTS: The two groups were comparable at baseline. After treatment with terlipressin, urine output significantly (P < 0.05) increased progressively in group A (day 4, 960 +/- 40 mL/24 h; day 8, 1068 +/- 56 mL/24 h) compared with group B (day 4, 451 +/- 40 mL/24 h; day 8, 291 +/- 45 mL/24 h). Creatinine clearance improved (P < 0.05) in group A (day 4, 20.2 +/- 2.1 mL/min; day 8, 35 +/- 2.8 mL/min) compared with group B (day 4, 11.3 +/- 1.3 mL/min; day 8, 9.3 +/- 1.7 mL/min). Serum creatinine decreased in group A but not in group B (day 8, 1.6 +/- 0.01 compared with 3.9 +/- 0.26, P < 0.05). Mean arterial pressure increased significantly (P < 0.05) in group A. Terlipressin administration was associated with transient self-limiting side-effects including crampy abdominal pain in two patients and cardiac arrhythmias in three patients. Five of the 12 patients survived in group A compared with none in group B at day 15 (P < 0.05) and all survivors had reversal of HRS. CONCLUSION: In patients with HRS, terlipressin significantly improved renal functions and systemic hemodynamics, and showed a trend towards better clinical outcome. The drug merits further evaluation with different dosages and longer schedules.     

Hepatorenal syndrome

Summary In patients with hepatorenal syndrome (HRS), 4-hr administration of a vasopressin analog has recently been shown to benefit renal blood flow and renal function. However, long-term effects and tolerance of this treatment have not been reported. We report a case of HRS that was controlled by the vasopressin analog, terlipressin. Because HRS repeatedly relapsed when treatment was discontinued, terlipressin, 2 mg/day was administered for 67 days, until liver transplantation could be performed in a patient with normal renal function. Except for limited cutaneous necrosis at an injection point, prolonged treatment with this vasopressin analog was well tolerated.     

特利加压素治疗肝肾综合征的疗效、预后及相关影响因素

目的观察特利加压素治疗肝肾综合征的疗效、预后,并分析相关的影响因素及临床意义。方法回顾性分析2012年1月至2014年12月第二军医大学附属长海医院使用特利加压素治疗的肝肾综合征患者,收集治疗前及治疗后的数据,观察特利加压素的疗效及预后。根据疗效的差异和预后的不同通过单因素分析筛选可能的影响因素,进一步采用Logistic回归和ROC分析验证。结果共收集到使用特利加压素治疗肝肾综合征患者96例,特利加压素的总体有效率为43.8%,肝肾综合征I型患者有效率为32.8%,肝肾综合征Ⅱ型患者的有效率为65.6%;MELD-Na评分,基线的内生肌酐清除率,是否合并感染是特利加压素疗效的影响因素;MELD-Na评分,总胆红素和特利加压素是否有效是预后的影响因素。结论特利加压素治疗肝肾综合征疗效确切,应尽早开始治疗,对于MELD-Na评分较高的患者可能疗效较差。     

Long-term outcome of patients treated with terlipressin for types 1 and 2 hepatorenal syndrome

Background: Studies suggest that terlipressin is effective in the treatment of hepatorenal syndrome (HRS). However, factors predicting response to therapy and the long‐term outcome of patients have not been defined. Methods: We reviewed all patients from our institution treated with terlipressin between July 1, 2001 and December 31, 2005 for HRS. Follow up continued until June 30, 2006. HRS was defined according to the International Ascites Club. The following data were retrieved: age, gender, etiology of liver disease, Child‐Pugh score, HRS precipitant, therapy duration, creatinine at day 0 and end of treatment, adverse events, and patient outcome. Results: Sixty‐nine patients were included. Forty‐nine episodes (71%) of HRS were type 1, and 20 episodes (29%) type 2. Forty‐one (59.4%) patients responded to terlipressin. Two variables predicted renal function improvement: type 1 HRS and age. Twenty‐one (30.4%) patients survived; 17 (81%) had type 1 HRS while four (19%) had type 2 HRS (P = 0.27). The only factor predicting transplant‐free survival was type 1 HRS. No patients with type 2 HRS survived without transplantation (P = 0.02). Conclusions: The only factor predicting transplant‐free survival following terlipressin therapy is the presence of type 1 HRS. Therefore, it is difficult to justify the use of this drug in patients with type 2 HRS who are not liver transplant candidates.     

Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome

Patients with advanced cirrhosis and ascites are characterized by circulatory dysfunction with splanchnic vasodilatation and renal vasoconstriction, which often lead to ascites. The vasoconstrictor terlipressin improves renal function in hepatorenal syndrome (HRS). The aim of this study was to evaluate if terlipressin also improves renal function in patients with ascites without HRS. Twenty-three patients with cirrhosis participated; 15 with nonrefractory ascites were randomized to either terlipressin (N group, n = 11) or a placebo (P group, n = 4), and 8 had refractory ascites and received terlipressin (R group). The glomerular filtration rate (GFR), sodium clearance (C(Na)), lithium clearance (C(Li)), osmolal clearance (C(Osm)), and urine sodium concentration (U(Na)) were assessed before and after the injection of 2 mg of terlipressin or the placebo. GFR increased in the N group (69 +/- 19 versus 92 +/- 25 mL/min, P < 0.005) and in the R group (31 +/- 19 versus 41 +/- 31 mL/min, P < 0.05) after terlipressin. In the N group, terlipressin induced an increase in C(Na) (0.89 +/- 0.21 versus 1.52 +/- 1.45 mL/min, P < 0.05), C(Li) (17.3 +/- 8.9 versus 21.5 +/- 11.6 mL/min, P < 0.05), and C(Osm) (2.10 +/- 0.81 versus 3.06 +/- 2.0 mL/min, P < 0.05). In the R group, terlipressin induced an increase in C(Na) (0.11 +/- 0.18 versus 0.35 +/- 0.40 mL/min, P < 0.05) and C(Li) (5.5 +/- 4.2 versus 9.5 +/- 8.55 mL/min, P < 0.05). U(Na) increased in both groups after terlipressin (P < 0.005). Plasma norepinephrine (P < 0.05) and renin (P < 0.05) decreased after terlipressin. All parameters remained unchanged after the placebo. Conclusion: The vasopressin 1 receptor agonist terlipressin improves renal function and induces natriuresis in patients with cirrhosis and ascites without HRS. Vasoconstrictors may represent a novel future treatment modality for these patients.