Abstract

Hepatorenal syndrome–acute kidney injury (HRS-AKI) is a severe complication of advanced liver cirrhosis associated with high morbidity and mortality. Terlipressin with albumin is the standard pharmacological treatment; however, intermittent bolus administration is associated with adverse events, particularly ischemic complications. Continuous terlipressin infusion has emerged as an alternative strategy to improve tolerability while maintaining efficacy. A systematic literature review was conducted in PubMed on June 5, 2026, to identify studies evaluating continuous terlipressin infusion in adults with HRS-AKI or type 1 hepatorenal syndrome. Eligible studies included randomized controlled trials, cohort studies, comparative studies, and case series with at least five patients. Data on treatment response, renal outcomes, adverse events, and mortality were extracted. Study quality was assessed using the RoB 2 tool and the Newcastle–Ottawa scale. Fifteen records were identified, of which three met the inclusion criteria and comprised 151 patients. The included studies comprised one randomized controlled trial and two observational cohort studies. Continuous terlipressin infusion achieved response rates of 76.5%–88.2%. Renal function improved across studies, with substantial reductions in serum creatinine levels. Adverse events ranged from 4% to 52.2%, and serious adverse events were uncommon. Compared with intermittent bolus administration, continuous infusion showed comparable efficacy with a potentially better safety profile. Continuous terlipressin infusion appeared to be an effective, well-tolerated treatment for HRS-AKI. It demonstrated high response rates, significant renal recovery, and a low incidence of serious adverse events. Larger prospective randomized studies are needed to confirm these findings.

Key words: Safety, efficacy, terlipressin infusion, hepatorenal syndrome, acute kidney injury, systematic review