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Evidence-Based Management of Hepatorenal Syndrome: Preserving Renal Function in Patients with Portal Hypertension

Evidence-Based Management of Hepatorenal Syndrome: Preserving Renal Function in Patients with Portal Hypertension


Slide Lecture Series

Time to Complete

1.25 hours


January 4, 2019


January 4, 2020
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Maximum Credits

1.25 / AMA PRA Category 1 CreditTM
1.25 / Pharmacy CE Contact Hours (0.125 CEUs)

Accredited Provider

This activity is jointly provided by Purdue University College of Pharmacy and CiME.

Commercial Supporter

Supported by an educational grant from Mallinckrodt Pharmaceuticals

Program Description

Hepatorenal syndrome (HRS) describes the reversible, functional renal impairment that occurs in patients who have advanced cirrhosis, arising portal hypertension, and/or those with fulminant hepatic failure. Most commonly encountered as acute kidney injury (AKI) in patients with decompensated cirrhosis, HRS is characterized by a reduction in glomerular filtration rate and renal plasma flow, in the absence of other causes of AKI. Prognosis is poor, with high mortality rates, and there are currently no approved pharmacotherapies to ameliorate the effects of HRS in the US.

This activity will discuss new information and approaches to identifying patients with or at risk for HRS; the application of evidence-based algorithms to the pharmacologic and surgical options for patients with suspected HRS, and shortening time to application of therapeutic interventions to maximize patient survival rates and outcomes.

Intended Audience

Hepatologists, Gastroenterologists, Nephrologists, Critical Care Medicine specialists

Educational Objectives

After completing this activity, participants should be better able to:

  • Describe the pathophysiology of acute kidney injury including hepatorenal syndrome in cirrhosis
  • Discuss the new diagnostic criteria for AKI/HRS in cirrhosis and definitions for response to treatment for AKI
  • Identify the appropriate timing of referral of patients with cirrhosis to a tertiary treatment center for evaluation and management for AKI/HRS
  • Evaluate the various treatment options available for AKI/HRS
  • Identify predictive factors for treatment response

Accreditor Disclosure of Conflicts of Interest Policy

It is the policy of both Purdue University College of Pharmacy and CiME to ensure independence, balance, objectivity, scientific rigor, and integrity in all their continuing education activities. All faculty, staff and reviewers involved in the planning, review or presentation of continuing education activities provided by Purdue University College of Pharmacy are required to disclose to the audience any relevant commercial financial affiliations related to the content of the presentation or enduring material. Full disclosure of all commercial relationships must be made in writing to the audience prior to the activity. Identified conflict of interest is resolved by Purdue University College of Pharmacy prior to accreditation of the activity.


Florence Wong, MBBS, MD, FRACP, FRCPC

Professor, Division of Gastroenterology
Department of Medicine
University of Toronto
Toronto, Ontario, Canada

Dr. Wong reports the following disclosures: Mallinckrodt (Grants/Research Support; Consultant; Honoraria Received)

Guadalupe Garcia-Tsao, MD

Professor of Medicine
Chief, Digestive Diseases, VA-CT Healthcare System
Director, Clinical and Translational Core, Yale Liver Center
Program Director, VA-CT Hepatitis C Resource Center
Yale School of Medicine
New Haven, Connecticut

Dr. Garcia-Tsao reports the following disclosures: Cook Pharmica (Consultant; Honoraria Received), Conatus Pharmaceuticals Inc (Consultant; Honoraria Received; Advisory Board); Galectin Therapeutics (Consultant; Honoraria Received; Advisory Board); BioVie (Advisory Board); Enterome Bioscience (Advisory Board); Genfit (Advisory Board); Grifols (Advisory Board); Intercept Pharmaceuticals (Advisory Board)

Hugo E. Vargas, MD
Professor of Medicine
Division of Gastroenterology and Hepatology
Department of Internal Medicine
Mayo Clinic
Phoenix, Arizona

Dr. Vargas reports the following disclosures: American Journal of Gastroenterology (Editorial Board); Enterome (Advisory Board); Grifols (Grants/Research Support); Mallinckrodt (Grants/Research Support); Transmedics (Data Safety Monitoring Board); Verily (Grants/Research Support)




AMA PRA Category 1 Credit(s)TM

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Purdue University College of Pharmacy and CiME. Purdue University College of Pharmacy, an equal access/equal opportunity institution, is accredited by the ACCME to provide continuing medical education for physicians.

Designation Statement

Purdue University College of Pharmacy designates this enduring activity for a maximum of 1.25 AMA PRA Category 1 CreditTM  . Physicians should claim only the credit commensurate with the extent of their participation in the activity.




CE for Pharmacists

Accreditation Statement

Purdue University College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This is a knowledge based, continuing education activity of Purdue University, an equal access/equal opportunity institution.

Designation Statement

Purdue University College of Pharmacy designates this enduring activity for a maximum of 1.25 Contact Hours (0.125 CEUs).

Accreditor Disclosure

All additional planning committee members, staff and reviewers of CiME and Purdue University College of Pharmacy have no relationships to disclose.

Disclosure of Unlabeled Use

This activity contains information of commercial products/devices that are unlabeled for use or investigational uses of products not yet approved. There is currently no pharmacologic agent approved by the US FDA for the treatment of HRS.


The views expressed in this activity are those of the faculty. It should not be inferred or assumed that they are expressing the views of the commercial supporter, any other manufacturer of pharmaceuticals or devices, Purdue University College of Pharmacy, or CiME.

It should be noted that the recommendations made herein with regard to the use of therapeutic agents, varying disease states, and assessments of risk are based upon a combination of clinical trials, current guidelines, and the clinical practice experience of the participating presenters. The drug selection and dosage information presented in this activity are believed to be accurate. However, participants are urged to consult all available data on products or procedures before using them in clinical practice.

Copyright © 2018 Purdue University College of Pharmacy and CiME, LLC. All rights reserved including translation into other languages. No part of this activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval systems, without permission in writing.


To obtain credit, a score of 70% or better on the post-test is required. This activity is offered at no cost to participants. Please proceed with the activity until you have successfully completed this program, answered all test questions, completed the post-test and evaluation, and have received a digital copy of your credit certificate. Your online certificate will be saved on myCME within your Profile/CME History, which you can access at any time.

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