HRS-AKI may be deadly, especially if left untreated

HRS with rapid reduction in kidney function is an acute condition that occurs in patients with decompensated cirrhosis and ascites.¹

WITHOUT TREATMENT

The longer treatment of HRS-AKI is delayed, the less reversible and more fatal it becomes²

<2 WEEKS

MEDIAN SURVIVAL TIME

>80%

MORTALITY WITHIN 3 MONTHS

WITH TREATMENT

Historically, patients with HRS have faced poor outcomes even with treatment^3,a-c

36.9%

IN-HOSPITAL RATE OF MORTALITY

33.1%

30-DAY RATE OF READMISSION

41.2% of readmissions were unplanned

30.5 DAYS

MEAN LENGTH OF STAY

^aPatient identification based on ICD coding, which does not differentiate types of HRS.

^bReason for discharge varied among patients and was not necessarily indicative of patient outcomes.

^cThese results do not include treatment with TERLIVAZ.

Earlier diagnosis can lead to better outcomes, as recommended by AASLD Guidance

Diagnose at lower SCr levels^1,4

Baseline creatinine (at the time of therapy initiation) is a well-known predictor of HRS reversal.

2021 AASLD GUIDANCE

All must be present for a proper HRS-AKI diagnosis^1,a

Cirrhosis with ascites
Increase in SCr ≥0.3 mg/dL from baseline within 48 hours or ≥50% increase in SCr that is known or presumed to have occurred within the preceding 7 days
No improvement after 48 hours of diuretic withdrawal and plasma volume expansion with albumin infusion (1 g/kg body weight per day)
Absence of shock
No current or recent treatment with nephrotoxic drugs (NSAIDs, aminoglycosides, or iodinated contrast media)
No signs of structural kidney injury, as indicated by proteinuria (>500 mg per day), microhematuria (>50 red blood cells per high-power field), and/or abnormal renal ultrasonography

^aDiagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Biggins SW, Angeli P, Garcia-Tsao G, Ginès P, Ling SC, Nadim MK, Wong F, Kim WR. Copyright © 2021 American Association for the Study of Liver Diseases. Reproduced with permission of John Wiley & Sons, Inc.

Put your knowledge about HRS‑AKI to the test

HRS-AKI is a rare condition that can be difficult to diagnose.¹ Do you think you know the signs and the steps needed to properly identify whether a patient has HRS-AKI?

PLAY THE GAME TO FIND OUT

IMPORTANT SAFETY INFORMATION

WARNING: SERIOUS OR FATAL RESPIRATORY FAILURE

TERLIVAZ® may cause serious or fatal respiratory failure. Patients with volume overload or with acute-on-chronic liver failure (ACLF) Grade 3 are at increased risk. Assess oxygenation saturation (e.g., SpO₂) before initiating TERLIVAZ.
Do not initiate TERLIVAZ in patients experiencing hypoxia (e.g., SpO₂ <90%) until oxygenation levels improve. Monitor patients for hypoxia using continuous pulse oximetry during treatment and discontinue TERLIVAZ if SpO₂ decreases below 90%.

INDICATION AND LIMITATION OF USE

TERLIVAZ is indicated to improve kidney function in adults with hepatorenal syndrome with rapid reduction in kidney function.

Patients with a serum creatinine >5 mg/dL are unlikely to experience benefit.

Contraindications

TERLIVAZ is contraindicated:

In patients experiencing hypoxia or worsening respiratory symptoms.
In patients with ongoing coronary, peripheral, or mesenteric ischemia.

Warnings and Precautions

Serious or Fatal Respiratory Failure: Obtain baseline oxygen saturation and do not initiate TERLIVAZ in hypoxic patients. Monitor patients for changes in respiratory status using continuous pulse oximetry and regular clinical assessments. Discontinue TERLIVAZ in patients experiencing hypoxia or increased respiratory symptoms.

Manage intravascular volume overload by reducing or discontinuing the administration of albumin and/or other fluids and through judicious use of diuretics. Temporarily interrupt, reduce, or discontinue TERLIVAZ treatment until patient volume status improves. Avoid use in patients with ACLF Grade 3 because they are at significant risk for respiratory failure.
Ineligibility for Liver Transplant: TERLIVAZ-related adverse reactions (respiratory failure, ischemia) may make a patient ineligible for liver transplantation, if listed. For patients with high prioritization for liver transplantation (e.g., MELD ≥35), the benefits of TERLIVAZ may not outweigh its risks.
Ischemic Events: TERLIVAZ may cause cardiac, cerebrovascular, peripheral, or mesenteric ischemia. Avoid use of TERLIVAZ in patients with a history of severe cardiovascular conditions or cerebrovascular or ischemic disease. Discontinue TERLIVAZ in patients who experience signs or symptoms suggestive of ischemic adverse reactions.
Embryo-Fetal Toxicity: TERLIVAZ may cause fetal harm when administered to a pregnant woman. If TERLIVAZ is used during pregnancy, the patient should be informed of the potential risk to the fetus.

Adverse Reactions

The most common adverse reactions (≥10%) include abdominal pain, nausea, respiratory failure, diarrhea, and dyspnea.

Please see full Prescribing Information, including Boxed Warning.

References: 1. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884 2. Flamm SL, Brown K, Wadei HM, et al. The current management of hepatorenal syndrome–acute kidney injury in the United States and the potential of terlipressin. Liver Transpl. 2021;27(8):1191-1202. doi:10.1002/lt.26072 3. Jamil K, Huang X, Lovelace B, Pham AT, Lodaya K, Wan G. The burden of illness of hepatorenal syndrome (HRS) in the United States: a retrospective analysis of electronic health records. J Med Econ. 2019;22(5):421-429. doi:10.1080/13696998.2019.1580201 4. Angeli P, Ginès P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut. 2015;64(4):531-537. doi:10.1136/gutjnl-2014-30887 5. Error in diagnostic algorithm. Correction. Hepatology. 2024;80(5):E89. doi:10.1097/HEP.0000000000000983

Early Diagnosis and Treatment