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Region Hovedstaden - en del af Københavns Universitetshospital
E-pub ahead of print

Dobutamine reverses the cardio-suppressive effects of terlipressin without improving renal function in cirrhosis and ascites: a randomised controlled trial

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DOI

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AIM: Acute kidney injury and hepatorenal syndrome (HRS) are frequent complications in patients with cirrhosis and ascites. First-line treatment is terlipressin, which reverses HRS in approximately 40% of patients but also lowers cardiac output (CO). We aimed to investigate whether reversing the cardio-suppressive effect of terlipressin with the β-adrenoceptor agonist dobutamine would increase CO and thereby the glomerular filtration rate (GFR).

METHODS: We randomised twenty-five patients with cirrhosis, ascites and impaired renal function (2:2:1): Group A received terlipressin followed by add-on of dobutamine, Group B received dobutamine and terlipressin as monotherapies and Group C received placebo. Renal and cardiac functions were assessed during 8 clearance periods of 30 minutes, and concentrations of vasoactive hormones were measured.

RESULTS: Dobutamine as a monotherapy increased CO (1.03 L/min, P<0.01) but had no significant effects on GFR. Renin (P<.05), angiotensin II (P<.005) and aldosterone (P<.05) increased after dobutamine infusion. Terlipressin as a monotherapy improved GFR (18.9 ml/min/m2, p=.005) and mean arterial pressure (MAP) (14 mmHg, P=.001) but reduced CO (-0.92 L/min, P<.005) and renin (P<.005). A combined treatment of dobutamine and terlipressin had a positive effect on CO (1.19 L/min, P<.05) and increased renin (P<.005), angiotensin II (P<.005) and aldosterone (P<.05), but it had no significant effects on MAP or GFR.

CONCLUSION: Dobutamine reversed the cardio-suppressive effect of terlipressin in cirrhosis, ascites and impaired renal function. However, dobutamine reduced peripheral vascular resistance, activated RAAS and did not improve GFR compared to terlipressin as a monotherapy. Therefore, dobutamine cannot be recommended in cirrhosis and ascites.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Physiology: Gastrointestinal and Liver Physiology
ISSN0193-1857
DOI
StatusE-pub ahead of print - 16 dec. 2019

ID: 58720105