Systemic, portal and renal effects of terlipressin in patients with cirrhotic ascites: pilot study.
Terlipressin is a vasopressin analog that may improve renal function in hepatorenal syndrome by mechanisms as yet unknown. The authors investigated the effect of the drug on systemic, hepatic and renal hemodynamics in cirrhosis. Six patients with cirrhosis and ascites were studied (five Child's B and one Child's C). Heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), hepatic venous pressure gradient (HVPG), reverse thermodilution unilateral real-time renal blood flow (RBF), urinary flow, and sodium concentrations were measured before and 1 h after an intravenous bolus of 2 mg of terlipressin. Following terlipressin administration, HR fell significantly (84.2 +/- 6 to 70.8 +/- 4.9, P = 0.013), MAP increased (72.7 +/- 3.6 to 87 +/- 5.3 mmHg, P = 0.027), CO fell (7.4 +/- 0.8 to 6.4 +/- 0.8 L/min, P = 0.02) and SVR increased (1368.5 +/- 236 to 2079.7 +/- 458, P = 0.04). There were no significant differences in HVPG (12.3 +/- 1.6 to 14 +/- 0.9 mmHg, P-value not significant [NS]), RBF (255 +/- 0.02 compared with 249 +/- 0.02 mL/min, P-value NS), urinary volume (49.1 +/- 8.9 compared with 49.6 +/- 16.7 mL/ h, P-value NS) and urinary sodium excretion (4 +/- 1.1 compared with 5.9 +/- 3.5 mmol/ h). In the present small study, the authors were able to demonstrate that a bolus injection of terlipressin produced an increase in MAP and SVR, along with a reduction in cardiac output without a reduction in renal blood flow. Further studies are necessary to define the effects of terlipressin on renal hemodynamics and sodium excretion.