Logo image
Back
S3215 Association of Midodrine Use With Renal and Transplant Outcomes in Patients With Hepatorenal Syndrome-Chronic Kidney Disease: A Propensity Score-Matched Analysis
Abstract   Peer reviewed

S3215 Association of Midodrine Use With Renal and Transplant Outcomes in Patients With Hepatorenal Syndrome-Chronic Kidney Disease: A Propensity Score-Matched Analysis

Abdullah Sohail, Jackson Snyder and Sara Naimimohasses
The American journal of gastroenterology, Vol.121(10S1), pp.S700-S700
10/01/2026
DOI: 10.14309/01.ajg.0001222112.75048.79

View Online

Abstract

Introduction: Midodrine is frequently used as an oral vasoconstrictor in patients with cirrhosis and hepatorenal syndrome–chronic kidney disease (HRS-CKD), particularly when intravenous vasopressors or terlipressin are not feasible. However, real-world data evaluating its association with renal outcomes in this population remain limited. We assessed whether midodrine use was associated with differences in clinical outcomes at 6 months and 1 year. Methods: We conducted a retrospective cohort study using the TriNetX Research Network, encompassing data from 109 healthcare organizations. Adults aged ≥18 years with HRS-CKD were identified using ICD-10-CM codes. The treatment cohort included patients who received midodrine; the control cohort included patients without midodrine exposure. Patients with pre-existing acute kidney failure, end-stage kidney disease, dialysis dependence, dialysis-related encounters, or prior kidney transplant were excluded. Propensity score matching was performed on demographics, comorbidities, and medications. After matching, 1,625 patients were included in each cohort. Results: At 180 days, mortality was similar between the control and midodrine cohorts (34.2% vs 33.0%; odds ratio [OR] 1.06, 95% CI 0.91–1.22; P = 0.458). Dialysis initiation occurred less frequently in the midodrine cohort (2.4% vs 3.9%; OR 1.64, 95% CI 1.09–2.46; P = 0.016), with time-to-event analysis confirming a lower dialysis risk (HR 1.58, 95% CI 1.06–2.36; log-rank P = 0.023). Kidney transplantation (1.0% vs 1.6%; P = 0.167) and liver transplantation (11.2% vs 12.0%; P = 0.476) did not differ significantly between groups. At 365 days, mortality remained similar (37.1% vs 36.0%; OR 1.05, 95% CI 0.91–1.21; P = 0.512). Dialysis initiation remained less frequent in the midodrine cohort (2.8% vs 4.5%; OR 1.62, 95% CI 1.11–2.35; P = 0.012), with consistent findings on time-to-event analysis (HR 1.55, 95% CI 1.08–2.25; log-rank P = 0.018). Kidney transplantation and liver transplantation rates did not differ significantly between groups at 1 year. Conclusion: In this large propensity score-matched cohort of patients with HRS-CKD, midodrine use was associated with a significantly lower risk of dialysis initiation at both 6 months and 1 year, while mortality, kidney transplantation, and liver transplantation rates did not differ significantly. These findings suggest that midodrine may confer a renal-protective benefit in HRS-CKD, although prospective trials are required to validate these findings.
 Hemodialysis Kidney Diseases Kidney transplants Liver transplants Mortality

Details

Metrics

1 Record Views
Logo image