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From Refractory Ascites to Dilutional Hyponatremia and Hepatorenal Syndrome: Current Options for Treatment

  • Portal Hypertension (JC Garcia-Pagán, Section Editor)
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Abstract

Cirrhosis is associated with high morbidity rates due to complications of portal hypertension. Ascites is the most frequent complication in patients with cirrhosis, and refractory ascites will develop in approximately 10 % of patients during follow-up. Currently, the first-line treatment for patients with refractory ascites is large-volume paracentesis with albumin supplementation. In more advanced stages of the disease, dilutional hyponatremia may develop as the result of nonosmotic hypersecretion of vasopressin. Although vaptans have shown promising results as a potential pharmacologic approach to treating hypervolemic hyponatremia, their results on long-term efficacy and safety in patients with cirrhosis are not conclusive. Moreover, because of concerns regarding side effects, the US Food and Drug Administration recently removed the indication of tolvaptan for use in patients with cirrhosis. Finally, in late stages of the disease, intense renal vasoconstriction occurs and leads to the development of hepatorenal syndrome. The treatment of choice for patients with hepatorenal syndrome is vasoconstrictor drugs followed by liver transplantation.

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Acknowledgments

Some of the studies reported in this review were performed with the support of grants from the Fondo de Investigación Sanitaria (FIS PI12/00330 and EC/90077) and Ciber de Enfermedades Hepáticas y Digestivas (CIBERehd). CIBERehd is funded by the Instituto de Salud Carlos III, Ministerio de Sanidad, España.

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Conflict of Interest

Elsa Solà, and Isabel Graupera declare that they have no conflicts of interest. Pere Ginès reports grants from Oprhan Therapeutics, and advisory board consultancy from Ferring Pharmaceuticals, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Liver Unit, Hospital Clínic, Barcelona. University of Barcelona School of Medicine, Barcelona, Spain

    Elsa Solà, Isabel Graupera & Pere Ginès

  2. Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Elsa Solà, Isabel Graupera & Pere Ginès

  3. Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain

    Elsa Solà, Isabel Graupera & Pere Ginès

  4. Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Barcelona, Spain

    Elsa Solà, Isabel Graupera & Pere Ginès

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  1. Elsa Solà
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Correspondence to Elsa Solà.

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Solà, E., Graupera, I. & Ginès, P. From Refractory Ascites to Dilutional Hyponatremia and Hepatorenal Syndrome: Current Options for Treatment. Curr Hepatology Rep 13, 189–197 (2014). https://doi.org/10.1007/s11901-014-0240-8

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