Re: Hepatorenal syndrome: pathophysiology, diagnosis, and management
Dear Editor,
The authors state that "albumin infusion is essential for effective management of AKI-HRS". This seems like a strong recommendation, and should be backed by high quality evidence. But the authors do not cite a single high-quality RCT to back their opinion. Instead, we are fed a litany of circumstantial evidence and one referenced non-randomised trial of 21 vs 13 pts (Terlipressin +/- albumin). Another study compares albumin to starches, which are now widely recognised to be nephrotoxic. This is hardly supportive of strong claims.
Rapid Response:
Re: Hepatorenal syndrome: pathophysiology, diagnosis, and management
Dear Editor,
The authors state that "albumin infusion is essential for effective management of AKI-HRS". This seems like a strong recommendation, and should be backed by high quality evidence. But the authors do not cite a single high-quality RCT to back their opinion. Instead, we are fed a litany of circumstantial evidence and one referenced non-randomised trial of 21 vs 13 pts (Terlipressin +/- albumin). Another study compares albumin to starches, which are now widely recognised to be nephrotoxic. This is hardly supportive of strong claims.
Competing interests: No competing interests