Effectiveness of Noradrenaline and Albumin vs. Terlipressin andAlbumin in Treating Hepatorenal Syndrome in Patients of ChronicLiver Disease

Liver cirrhosis is the end result of persistent and chronic hepatocellular injury.It is an irreversible pathological 1 process featured by fibrosis and nodular regeneration.The number of deaths due to this lethal disease is among 2 the highest worldwide.Around 8 million people live with HCV in Pakistan according to a National Hepatitis Survey.This ultimately leads to end stage liver disease, 3 cirrhosis, and hepatocellular carcinoma (HCC).The complications of cirrhosis e.g., hepatic encephalopathy, upper gastrointestinal bleed, Hepatorenal Syndrome (HRS) and hepatopulmonary syndrome, cause a high 4 mortality rate of the disease.Hepatorenal syndrome is defined as the occurrence of renal failure in a patient with advanced liver disease in 5 the absence of an identifiable cause of renal failure.It is a severe and progressive functional renal failure in 6 patients with chronic liver disease.It also occurs in patients with acute fulminant hepatitis who have portal 7 hypertension and ascites.Mechanism for development of hepatorenal syndrome is still unclear.It includes renal vasoconstriction and arteriolar vasodilation in splanchnic system and reduced peripheral vascular resistance, while arterial vasodilation leads to a decrease in the effective blood volume, homeostatic activation of vasoactive systems and, consequently, renal vasoconstriction.Other pathogenetic mechanisms include increased endo-8 thelin concentration and adenosine level.Treatment of HRS includes the arterial vasoconstrictors, causing a vasoconstriction of the extremely dilated splanchnic vascular bed and increasing arterial pressure.The vasopressin analog terlipressin is the most widely Abstract Objective: To compare the efficacy of noradrenaline and albumin versus terlipressin and albumin in the treatment of hepato-renal syndrome in patients with chronic liver disease.Methods: This was a randomized controlled trial conducted from 2nd August 2022 to 1st February 2023 at the Department of Medicine & Gastroenterology, Medical unit III, Services Hospital Lahore.A total of 70 patients of age 18 to 70 years, both genders, diagnosed with chronic liver disease (CLD) having HRS were included.Patients with chronic kidney disease (CKD), history of ischemic heart disease, arrhythmias or cardiomyopathy were excluded.Group A received Inj.Terlipressin 1mg x 6 hourly along with Inj.Albumin 1 mg/kg on day 1 and then 20 mg/day.Group B received Nordrenaline initially 1 mg/hour along with Inj.Albumin 1 mg/kg on day 1 and then 20mg/day.Patients were followed for 48 hours.If there was decline of serum creatinine < 1.5 mg/dl within 48 hours, then efficacy was labeled.Results: In our study, efficacy of noradrenaline and albumin was 80.0% versus 37.14% in terlipressin and albumin in treatment of hepato-renal syndrome in patients of CLD. Conclusion:This study concluded that efficacy of noradrenaline and albumin is better than terlipressin and albumin in treatment of hepato-renal syndrome in patients of chronic liver disease.