Liver Lineup: Advances in Portal Hypertension and Cirrhosis Management

Published on: January 5, 2026

Reau and Brown discuss new data on SGLT2 inhibitors, albumin dosing, AKI risk, and emerging at-home tools for hepatic encephalopathy in cirrhosis.

In this episode of Liver Lineup: Updates and Unfiltered Insights, hosts Kimberly Brown, MD, and Nancy Reau, MD, break down several of the most consequential hepatology developments of 2025, focusing on practical advances in the management of patients with advanced liver disease. From renal protection in metabolic dysfunction-associated steatotic liver disease (MASLD) cirrhosis to long-debated questions around albumin dosing and emerging tools for monitoring hepatic encephalopathy at home, the discussion centers on how new data may begin to shift everyday clinical decision-making.

The discussion opens with a conversation about SGLT2 inhibition in patients with MASLD-associated cirrhosis and ascites, a population known to be at high risk for chronic kidney disease. Brown reviews data showing that dapagliflozin significantly reduced the development of CKD over 12 months compared with standard of care, while also improving ascites control and reducing diuretic requirements. Of note, the drug appeared safe and well tolerated, with minimal discontinuation and no major metabolic compromise. Reau says the findings challenge long-held assumptions and highlight a potentially practice-changing option for patients who are poor candidates for TIPS or transplantation.

From there, the conversation turns to albumin, an enduring and controversial therapy in hepatology. Brown summarizes new evidence suggesting that short-term albumin administration can improve serum sodium levels and may reduce mortality in patients with cirrhosis and dilutional hyponatremia. While the study was modest in size, both hosts emphasize its relevance to hospitalized patients with severe hyponatremia, particularly those being bridged to transplant.

That theme continues with a review of data comparing low-dose versus conventional-dose albumin in patients with cirrhosis and high-risk spontaneous bacterial peritonitis. Findings suggest that lower dosing may be noninferior for preventing acute kidney injury while substantially reducing the risk of circulatory overload. Reau reflects on how these results challenge long-standing dogma embedded in order sets and guidelines, reinforcing the importance of individualized volume assessment rather than fixed dosing schemas.

The episode closes with a look toward the future of outpatient monitoring in advanced liver disease, highlighting a novel at-home critical flicker frequency device designed to detect minimal hepatic encephalopathy. With high adherence, short testing times, and stable measurements over weeks, the technology offers a glimpse into how digital tools and remote monitoring could help identify cognitive decline earlier, before patients present with overt encephalopathy or hospitalization.

Together, these discussions capture some of the most impactful hepatology headlines of 2025: a growing emphasis on renal protection in cirrhosis, a reevaluation of albumin’s role and dosing, and the integration of technology into chronic liver disease management.

Editors’ note: Relevant Disclosures for Reau include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for Brown include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal.

References

Jain A. Maiwall R, Tevethia HV, et al. Dapagliflozin can reduce the incidence of chronic kidney disease in metabolic dysfunction associated steatotic liver disease associated cirrhosis patients with moderate ascites. A randomized controlled trial (DAPA-CLD). Presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025. Washington, DC. November 7-11, 2025.
Juanola A, Moreta M, Sole C, et al. SHORT-TERM HUMAN ALBUMIN THERAPY IMPROVES SERUM SODIUM CONCENTRATION AND REDUCES MORTALITY IN PATIENTS WITH CIRRHOSIS AND DILUTIONAL HYPONATREMIA. Presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025. Washington, DC. November 7-11, 2025.
Paul S, Sharma MK, Maiwall R, et al. Efficacy and Safety of Low-Dose Versus Conventional Dose Albumin for Prevention of Acute Kidney Injury in Cirrhosis and High-Risk Spontaneous Bacterial Peritonitis: A Randomized Controlled Trial. Presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025. Washington, DC. November 7-11, 2025.
Vutien P, Li R, Karkar R, et al. Beacon: At-Home, Self-Administration of a Test for Critical Flicker Frequency as a Screening Test for Minimal Hepatic Encephalopathy. Presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025. Washington, DC. November 7-11, 2025.

Liver Lineup: Advances in Portal Hypertension and Cirrhosis Management

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References