Open labelled randomized control study on continuous intravenous infusion versus intravenous boluses of terlipressin in the management of HRS

Hepatorenal syndrome is a severe complication of cirrhosis of live that occurs characteristically in patients with ascites. Terlipressin plus albumin is the most commonly used therapeutic option for the treatment of hepatorenal syndrome. According to the peripheral arterial vasodilation hypothesis, terlipressin was introduced to counteract the splanchanic arterial vasodilation to reduce portal hypertension and to improve the reduced effective circulating volume, both thought to be pivotal factors in the pathogenesis of HRS. The effect of terlipressin on splanchnic hemodynamics, namely the reduction of portal pressure, was tested in patients with cirrhosis, it was shown that it lasted no more than 3 to 4 hours after the intravenous olus of the drug. Therefor, this cannot ensure that the drug is able to exert its positive effect on arterial splanchnic hemodynamics and continue to maintain its effect for 24 hours. Terlipressin given by continous intravenous infusion was found to be effective even when given at low dose, suggesting that it may be effective at doses lower than those required for intravenous bolus adminstration.

This Randomised control trial has been designated to evaluate whether terlipressin given by continuous intravenous infusion is more suitable approach than terlipressin given by intravenous boluses in the treatment of HRS-AKI.

Study hypothesis is that terlipressin given by infusion is safer, efficacious at lower doses when compared to Terlipressin given as intermittent boluses.