Letter in response to the recently published review: Hyponatremia in cirrhosis and end-stage liver disease - Treatment with the vasopressin V2-receptor antagonist tolvaptan

摘要

Hyponatremia as defined equal to or lower than 135 mEq/L is prevalent in up to 50 % of cirrhotics [1] and is an important indicator and cause of increased morbidity and mortality [2]. Conventional management of cirrhotic patients with ascites with certain diuretics may exacerbate hyponatremia. Therefore, the recent comprehensive review on the use of vaptans in the hyponatremia in cirrhosis by Gaglio et al. [3] was very timely. This class of drug acts as an antagonist at Vasopressin (V)-type receptors in the renal collecting ducts. Tolvaptan is a V2 receptor antagonist and Conivaptan a V1a/V2 receptor antagonist. Tolvaptan and conivaptan are currently approved for use in hypervolemic and euvolemic hyponatremia. Vaptans may provide benefit to those cirrhotic patients not responding adequately to current standards of treatment.