**15. Renal support therapies in hepatorenal syndrome**

The use of renal supportive therapy is indicated when patients with hepatorenal syndrome develop absolute indications for renal supportive therapy (RST) (severe metabolic acidosis, severe hyperkalemia, fluid overload, encephalopathy, and uremia) in nonresponders to the use of Terlipressin with albumin.

AKI, due to HRS and ATN, has a poor prognosis because 40% require RST and 60% die within 90 days [72]. In a retrospective cohort of 472 patients with diagnoses of HRS and ATN, 341 of these did not enter the waiting list and 131 were included on the waiting list. It was evident that those who developed HRS presented higher SOFA and MELD scores and patients with ATN presented sepsis and required vasopressors and mechanical ventilation. The 6-month survival for those who were not placed on the waiting list with HRS (84%) and ATN (85%) was similar. The RST start is controversial in patients who are not candidates for liver transplantation because it does not modify the prognosis.

At this point, three scenarios are proposed [73]:

