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The Management of Hyponatremia in Cirrhosis: Should it Be Pharmacologic?

  • Management of the Cirrhotic Patient (NS Reau and A Cardenas, Section Editors)
  • Published:
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Abstract

Hyponatremia is a common complication of patients with advanced cirrhosis that is associated with increased morbidity and mortality. Patients with cirrhosis may develop two types of hyponatremia: hypovolemic or hypervolemic hyponatremia. Hypervolemic hyponatremia is the most frequent type of hyponatremia that develops in patients with advanced liver disease and is the consequence of impairment in the renal capacity to eliminate solute-free water. The pathogenesis of these increased solute-free water retention involves several factors, but the most important one is a non-osmotic hypersecretion of vasopressin. The treatment of choice for hypervolemic hyponatremia is fluid restriction. Vaptans, drugs that are selective antagonists of vasopressin V2 receptors, emerged as the first pharmacological treatment of hypervolemic hyponatremia in cirrhosis with promising results. However, satavaptan was withdrawn from development for safety reasons and tolvaptan is not recommended in patients with liver disease. Therefore, currently there is no effective and safe pharmacological approach available for the management of hypervolemic hyponatremia in cirrhosis.

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Acknowledgments

Some of the work discussed in this review has been funded by the FIS PI12/00330 integrated in the Plan Nacional I+D+I and co-funded by ISCIII-Subdirección General de Evaluación and European Regional Development Fund (ERDF). CIBEREHD is funded by the Instituto de Salud Carlos III. Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR) 2014 SGR 708. Pere Ginès is recipient of an ICREA Academia Award.

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Authors and Affiliations

  1. Liver Unit, Hospital Clínic, Universitat de Barcelona., Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD). Instituto Reina Sofía de Investigación Nefrológica (IRSIN)., 08036, Barcelona, Spain

    Elsa Solà, Patricia Huelin & Pere Ginès

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  1. Elsa Solà
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  2. Patricia Huelin
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Correspondence to Pere Ginès.

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Elsa Solà, Patricia Huelin, and Pere Ginès declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

With regard to the authors’ research cited in this paper, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article is part of the Topical Collection on Management of the Cirrhotic Patient

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Solà, E., Huelin, P. & Ginès, P. The Management of Hyponatremia in Cirrhosis: Should it Be Pharmacologic?. Curr Hepatology Rep 15, 53–59 (2016). https://doi.org/10.1007/s11901-016-0293-y

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  • DOI: https://doi.org/10.1007/s11901-016-0293-y

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