Systemic reviews and meta-analysis of the use of midodrine in hepatorenal syndrome

Aims. This study analyzes the effectiveness of midodrine in reducing or managing Hepatorenal Syndrome (HRS). Design. A systematic review and meta-analysis were conducted to gather and assess relevant literature. The review included evaluating study aims, methodologies, outcomes, and implications, with data presented in a tabular format for clarity. The protocol specified the search strategy, selection criteria, and data extraction methods for transparency. Data sources. Articles were sourced from Google Scholar and PubMed using inclusion and exclusion criteria. Quality assessment data were extracted, synthesized, analyzed, and reported. Review methods. The systematic review focused on peer-reviewed journals, considering factors such as time, language, and full-length article availability. Studies were excluded if they were duplicates, abstracts only, or non-English. Results. Midodrine was found to improve arterial pressure and renal function in HRS patients, suggesting a link between circulatory and renal functions. Sample sizes varied across studies, with some involving small patient groups. Terlipressin appeared more effective than midodrine and octreotide in improving renal function due to its impact on mean arterial pressure (MAP). Specific findings included significant increases in arterial pressure and renal function improvement in both treatment and control groups. Conclusion. Midodrine shows potential in managing HRS, decreasing nitrite and nitrate levels in ascites patients, and improving renal function. However, significant, well-designed clinical trials are needed to determine optimal dosage, duration, and pharmacological side effects. The meta-analysis highlights opportunities for further research on midodrine in combination treatments and cost-effectiveness evaluations. Impact. This study opens avenues for future research on midodrine's role in HRS treatment, particularly in combination therapies and cost-effectiveness studies.