Droxidopa to Increase Mean Arterial Pressure in Decompensated Cirrhosis Patients With Acute Kidney Injury

Inclusion Criteria: * Ability to provide informed consent by subject or legally authorized representative * Consent to blood and urine collection for biomarker analysis * Ability to take oral medications * At least 18 years of age * Hospitalized at Columbia University Irving Medical Center * Child-Pugh Score ≥ B7 cirrhosis (documented by imaging, biopsy, or clinical evidence) * KDIGO Stage 1 AKI or greater, defined as: * ≥0.3 mg/dL increase in serum creatinine within 48 hours OR * ≥50% increase in serum creatinine from outpatient baseline * Mean arterial pressure ≤85 mmHg averaged over 24 hours prior to randomization * For women of childbearing potential: negative pregnancy test and agreement to use effective contraception Exclusion Criteria: * Serum creatinine \>4.0 mg/dL or current renal replacement therapy * Age \>70 years * Severe cardiovascular disease, including: * Unstable angina * Congestive heart failure requiring escalating medical therapy * Symptomatic peripheral vascular disease * Any cardiovascular condition deemed severe by investigator * Active gastrointestinal bleeding, defined as requiring ≥ 2 units of packed red blood cells during the screening period * Acute respiratory failure requiring more than 6L of Nasal Canula * Use of medications that could interact with droxidopa including: * MAOI inhibitors * Norepinephrine reuptake inhibitors * Other investigational drugs * Pregnancy or breastfeeding * Any episode of a SBP ≥ 180 mmHg or a DBP ≥ 120 mmHg on two measurements, 1 minute apart * Prior liver transplantation