On 2015 May 20, NephJC - Nephrology Journal Club commented:

This study was discussed on May 12th and 13th in the open online nephrology journal club, #NephJC, on twitter.

Introductory comments are available at the NephJC website. The discussion was quite detailed, with more than 65 participants, including nephrologists, gastroenterologists and also input from the senior author, Professor Paulo Angeli.

A transcript and a curated (i.e. Storified) version of the tweetchat are available at the NephJC website.

The highlights of the tweetchat were:

• The authors, with research funding from the University of Padova, should be commended for conducting this elegant and well-thought out trial, which was stopped early after the interim analysis reported a superiority of the intervention (terlipressin) compared to the standard therapy (midodrine+ octreotide).

• There was some discussion around a few factors/issues: the fact that acute kidney injury in hepatorenal syndrome is a heterogenous entity and whether using biomarkers in conjunction to guide patient selection would have been helpful; concern about the early stopping and whether power/sample size should have taken interim analysis into account; the possibility that the continuous terlipressin infusion, used in this study, perhaps is more effective than bolus dosing used previously (and which will be tested in an ongoing trial by the same group of authors).

• There was a transatlantic divide in the approach to such patients. Terlipressin is not available in North America, and the evidence from this trial did not convince most participants in the American chat; on the other hand, terlipressin is available in most of Europe and UK, and the participants in that chat felt this data supported their standard of care.

Interested individuals can track and join in the conversation by following @NephJC or #NephJC, or visit the webpage at NephJC.com.

On 2015 May 20, NephJC - Nephrology Journal Club commented:

This study was discussed on May 12th and 13th in the open online nephrology journal club, #NephJC, on twitter.

Introductory comments are available at the NephJC website. The discussion was quite detailed, with more than 65 participants, including nephrologists, gastroenterologists and also input from the senior author, Professor Paulo Angeli.

A transcript and a curated (i.e. Storified) version of the tweetchat are available at the NephJC website.

The highlights of the tweetchat were:

• The authors, with research funding from the University of Padova, should be commended for conducting this elegant and well-thought out trial, which was stopped early after the interim analysis reported a superiority of the intervention (terlipressin) compared to the standard therapy (midodrine+ octreotide).

• There was some discussion around a few factors/issues: the fact that acute kidney injury in hepatorenal syndrome is a heterogenous entity and whether using biomarkers in conjunction to guide patient selection would have been helpful; concern about the early stopping and whether power/sample size should have taken interim analysis into account; the possibility that the continuous terlipressin infusion, used in this study, perhaps is more effective than bolus dosing used previously (and which will be tested in an ongoing trial by the same group of authors).

• There was a transatlantic divide in the approach to such patients. Terlipressin is not available in North America, and the evidence from this trial did not convince most participants in the American chat; on the other hand, terlipressin is available in most of Europe and UK, and the participants in that chat felt this data supported their standard of care.

Interested individuals can track and join in the conversation by following @NephJC or #NephJC, or visit the webpage at NephJC.com.