Elisa Pose1, Elsa Solà2, Salvatore Piano3, Elisabetta Gola3, Isabel Graupera1, Mónica Guevara1, Andrés Cárdenas4, Paolo Angeli3, Pere Ginès1. 1. Liver Unit, Hospital Clínic, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Instituto Reina Sofía de Investigación Nefrológica, Spain. 2. Liver Unit, Hospital Clínic, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; Instituto Reina Sofía de Investigación Nefrológica, Spain. Electronic address: esola@clinic.ub.es. 3. Unit of Hepatic Emergencies and Liver Transplantation, Department of Medicine, University of Padova, Italy. 4. Institute of Digestive Diseases and Metabolism, Hospital Clinic, University of Barcelona, Spain.
Abstract
BACKGROUND: Vaptans, vasopressin selective V2-receptor antagonists, represent the first pharmacologic approach to the treatment of hypervolemic hyponatremia in cirrhosis. However, information on the use of vaptans for patients with cirrhosis and hyponatremia in a real-life scenario is limited. Therefore, this study evaluated the effect of tolvaptan on serum sodium in patients with cirrhosis and severe hypervolemic hyponatremia. METHODS: Nine patients with cirrhosis and serum sodium ≤125 mEq/L were included. RESULTS: Only 2 of the 9 patients (22%) gained an increase in serum sodium >130 mEq/L that persisted throughout treatment. In the remaining patients, serum sodium did not change or increased during the first days but decreased thereafter despite continuation of treatment. Only 1 patient developed hyperkalemia as a side effect. CONCLUSIONS: The efficacy of tolvaptan in patients with cirrhosis and severe hypervolemic hyponatremia seems to be limited.
BACKGROUND:Vaptans, vasopressin selective V2-receptor antagonists, represent the first pharmacologic approach to the treatment of hypervolemic hyponatremia in cirrhosis. However, information on the use of vaptans for patients with cirrhosis and hyponatremia in a real-life scenario is limited. Therefore, this study evaluated the effect of tolvaptan on serum sodium in patients with cirrhosis and severe hypervolemic hyponatremia. METHODS: Nine patients with cirrhosis and serum sodium ≤125 mEq/L were included. RESULTS: Only 2 of the 9 patients (22%) gained an increase in serum sodium >130 mEq/L that persisted throughout treatment. In the remaining patients, serum sodium did not change or increased during the first days but decreased thereafter despite continuation of treatment. Only 1 patient developed hyperkalemia as a side effect. CONCLUSIONS: The efficacy of tolvaptan in patients with cirrhosis and severe hypervolemic hyponatremia seems to be limited.