Treatment of Portal Hypertension in Hepatorenal Syndrome–CKD (HRS-CKD) Complicating Cirrhosis with eGFR Below 60 mL/min/1.73 m²

Portal hypertension in the context of liver cirrhosis can be further complicated by hepatorenal syndrome–chronic kidney disease (HRS-CKD), a distinct renal phenotype that demands a targeted management strategy to preserve kidney function.

Clinical Scenario

This protocol addresses patients with portal hypertension and established liver cirrhosis who fulfil the criteria for HRS-CKD: an eGFR below 60 mL/min/1.73 m² sustained for more than three months in the absence of structural renal disease.

Treatment Approach

Management in this setting involves vasopressor therapy maintained on a long-term basis, reflecting the high risk of recurrence once renal function is impaired. The approach also incorporates specific considerations around diuretic selection and management of refractory ascites. The complete agent selection, sequencing, and fluid management strategy are available in the full protocol.

Clinical Goal

The primary treatment target in HRS-CKD is improvement in renal function.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jceh.2022.03.002

If the eGFR is less than 60 mL/min/1.73 m2 for more than three months in the absence of structural renal disease, then the patient is labeled as HRS-CKD.

Terlipressin has excellent efficacy in HRS-CKD; however, the risk of recurrence is high and patients need to be maintained on long-term therapy.

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