Prognosis for patients with HRS is poor. HRS-acute kidney injury (HRS-AKI) has a hospital survival of less than 10%, and median survival time is 2 weeks.[20]Gines P, Guevara M, Arroyo V, et al. Hepatorenal syndrome. Lancet. 2003 Nov 29;362(9398):1819-27.
http://www.ncbi.nlm.nih.gov/pubmed/14654322?tool=bestpractice.com
[49]Guevara M, Ginès P. Hepatorenal syndrome. Dig Dis. 2005;23(1):47-55.
https://www.karger.com/Article/Pdf/84725
http://www.ncbi.nlm.nih.gov/pubmed/15920325?tool=bestpractice.com
One systematic review and meta-analysis that included fourteen randomised controlled trials (conducted between 2002 and 2018) reported a pooled survival rate of 34.6% among patients with HRS-AKI.[50]Thomson MJ, Taylor A, Sharma P, et al. Limited progress in hepatorenal syndrome (HRS) reversal and survival 2002-2018: a systematic review and meta-analysis. Dig Dis Sci. 2020 May;65(5):1539-48.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103565
http://www.ncbi.nlm.nih.gov/pubmed/31571102?tool=bestpractice.com
In one retrospective cohort study of 11 hospital networks comprising 2063 hospitalised patients with cirrhosis and AKI, the 90-day mortality of patients with HRS-AKI was found to be 49%.[10]Patidar KR, Belcher JM, Regner KR, et al. Incidence and outcomes of acute kidney injury including hepatorenal syndrome in hospitalized patients with cirrhosis in the US. J Hepatol. 2023 Dec;79(6):1408-17.
http://www.ncbi.nlm.nih.gov/pubmed/37517455?tool=bestpractice.com
HRS-NAKI has a median survival time of around 6 months. The severity of underlying liver disease is a factor in the ability to recover from the renal failure.[20]Gines P, Guevara M, Arroyo V, et al. Hepatorenal syndrome. Lancet. 2003 Nov 29;362(9398):1819-27.
http://www.ncbi.nlm.nih.gov/pubmed/14654322?tool=bestpractice.com
The 1-year survival for HRS-NAKI is 38.5%.[51]Planas R, Montoliu S, Balleste B, et al. Natural history of patients hospitalized for management of cirrhotic ascites. Clin Gastroenterol Hepatol. 2006;4:1385-1394.
http://www.ncbi.nlm.nih.gov/pubmed/17081806?tool=bestpractice.com
In patients with HRS, liver transplantation offers a clear benefit.[52]Boyer TD, Sanyal AJ, Garcia-Tsao G, et al. Impact of liver transplantation on the survival of patients treated for hepatorenal syndrome type 1. Liver Transpl. 2011 Nov;17(11):1328-32.
https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/lt.22395
http://www.ncbi.nlm.nih.gov/pubmed/21837734?tool=bestpractice.com
HRS is reversible in about 83% of patients after liver transplant. However, the post-transplant mortality of patients with HRS is higher than that of patients without HRS.[53]Utako P, Emyoo T, Anothaisintawee T, et al. Clinical outcomes after liver transplantation for hepatorenal syndrome: a systematic review and meta-analysis. Biomed Res Int. 2018 May 24:2018:5362810.
https://onlinelibrary.wiley.com/doi/10.1155/2018/5362810
http://www.ncbi.nlm.nih.gov/pubmed/29992152?tool=bestpractice.com