Ornipressin in the treatment of functional renal failure in decompensated liver cirrhosis

In 11 patients with decompensated cirrhosis and deteriorating renal
function, the effect of the vasoconstrictor substance 8-ornithin
vasopressin (ornipressin; POR 8; Sandoz, Basel, Switzerland) on
renal function, hemodynamic parameters, and humoral mediators was
studied. Ornipressin was infused at a dose of 6 IU/h over a period
of 4 hours. During ornipressin infusion an improvement of renal
function was achieved as indicated by significant increases in
inulin clearance (+65%), paraaminohippuric acid clearance (+49%),
urine volume (+45%), sodium excretion (+259%), and fractional
elimination of sodium (+130%). The hyperdynamic circulation was
reversed to a nearly normal circulatory state. The increase in
systemic vascular resistance (+60%) coincided with a decrease of a
previously elevated renal vascular resistance (-27%) and increase
in renal blood flow (+44%). The renal fraction of the cardiac
output increased from 2.3% to 4.7% (P less than 0.05). A decline of
the elevated plasma levels of noradrenaline (2.08-1.13 ng/mL; P
less than 0.01) and renin activity (27.6-14.2 ng.mL-1.h-1; P less
than 0.01) was achieved. The plasma concentration of the atrial
natriuretic factor increased in most of the patients, but slightly
decreased in 3 patients. The decrease of renal vascular resistance
and the increase of renal blood flow and of the renal fraction of
cardiac output play a key role in the beneficial effect of
ornipressin on renal failure. These changes develop by an increase
in mean arterial pressure, the reduction of the sympathetic
activity, and probably of an extenuation of the splanchnic
vasodilation. A significant contribution of atrial natriuretic
factor is less likely. The present findings implicate that
treatment with ornipressin represents an alternative approach to
the management of functional renal failure in advanced liver
cirrhosis.