Vaptans and Hyponatremia in Critical Patients

Overview

Journal Transl Med UniSa

Date 2013 Aug 2

PMID 23905047

Citations 6

Authors

David DAuria

Geremia Zito Marinosci

Giuseppe De Benedictis

Ornella Piazza

Affiliations

Soon will be listed here.

Abstract

Hyponatremia is the most frequent fluid and electrolyte disorder in hospitalized patients (20%), particularly in ICU, associated with an increase in morbility and mortality. While hypovolaemic hyponatremia needs to be corrected with the replacement of the lost extracellular fluid by isotonic saline, euvolaemic (SIADH) and hypervolaemic hyponatremia (oedematous states like decompensated heart failure, liver cirrhosis, i.e.) are treated by restriction of fluid intake, loop diuretics and hypertonic saline. A novel approach consists in use of vaptans, non-peptide arginine vasopressin (AVP) receptor antagonists. Vaptans cause "aquaresis", which results in the correction of plasma osmolality and serum sodium levels, without activation of the renin-angiotensin-aldosterone system or changes in blood pressure and renal function. In this paper we critically reviewed the results of the available randomized controlled critical trials, discussing the effectiveness and safety of vaptans in treating hypervolaemic and euvolaemic hyponatremia in critical patients.

Citing Articles

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Tolvaptan Treatment in Children with Chronic Hyponatremia due to Inappropriate Antidiuretic Hormone Secretion: A Report of Three Cases.

Tuli G, Tessaris D, Einaudi S, de Sanctis L, Matarazzo P J Clin Res Pediatr Endocrinol. 2017; 9(3):288-292.

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References

Schrier R, Gross P, Gheorghiade M, Berl T, Verbalis J, Czerwiec F . Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. 2006; 355(20):2099-112. DOI: 10.1056/NEJMoa065181. View

Hoorn E, Lindemans J, Zietse R . Development of severe hyponatraemia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transplant. 2005; 21(1):70-6. DOI: 10.1093/ndt/gfi082. View

Annane D, Decaux G, Smith N . Efficacy and safety of oral conivaptan, a vasopressin-receptor antagonist, evaluated in a randomized, controlled trial in patients with euvolemic or hypervolemic hyponatremia. Am J Med Sci. 2008; 337(1):28-36. DOI: 10.1097/MAJ.0b013e31817b8148. View

Gheorghiade M, Gottlieb S, Udelson J, Konstam M, Czerwiec F, Ouyang J . Vasopressin v(2) receptor blockade with tolvaptan versus fluid restriction in the treatment of hyponatremia. Am J Cardiol. 2006; 97(7):1064-7. DOI: 10.1016/j.amjcard.2005.10.050. View

Konstam M, Gheorghiade M, Burnett Jr J, Grinfeld L, Maggioni A, Swedberg K . Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA. 2007; 297(12):1319-31. DOI: 10.1001/jama.297.12.1319. View

Chan P, Coupet J, Park H, Lai F, Hartupee D, CERVONI P . VPA-985, a nonpeptide orally active and selective vasopressin V2 receptor antagonist. Adv Exp Med Biol. 1999; 449:439-43. DOI: 10.1007/978-1-4615-4871-3_55. View

Galton C, Deem S, Yanez N, Souter M, Chesnut R, Dagal A . Open-label randomized trial of the safety and efficacy of a single dose conivaptan to raise serum sodium in patients with traumatic brain injury. Neurocrit Care. 2011; 14(3):354-60. DOI: 10.1007/s12028-011-9525-8. View

Hawkins R . Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. 2003; 337(1-2):169-72. DOI: 10.1016/j.cccn.2003.08.001. View

Adrogue H . Consequences of inadequate management of hyponatremia. Am J Nephrol. 2005; 25(3):240-9. DOI: 10.1159/000086019. View

10.

Zeltser D, Rosansky S, van Rensburg H, Verbalis J, Smith N . Assessment of the efficacy and safety of intravenous conivaptan in euvolemic and hypervolemic hyponatremia. Am J Nephrol. 2007; 27(5):447-57. DOI: 10.1159/000106456. View

11.

Adrogue H, Madias N . Hyponatremia. N Engl J Med. 2000; 342(21):1581-9. DOI: 10.1056/NEJM200005253422107. View

12.

Aronson D, Verbalis J, Mueller M, Krum H . Short- and long-term treatment of dilutional hyponatraemia with satavaptan, a selective arginine vasopressin V2-receptor antagonist: the DILIPO study. Eur J Heart Fail. 2011; 13(3):327-36. DOI: 10.1093/eurjhf/hfq226. View

13.

Feldman B, Rosenthal S, Vargas G, Fenwick R, Huang E, Matsuda-Abedini M . Nephrogenic syndrome of inappropriate antidiuresis. N Engl J Med. 2005; 352(18):1884-90. PMC: 5340184. DOI: 10.1056/NEJMoa042743. View

14.

Nielsen S, Frokiaer J, Marples D, Kwon T, Agre P, Knepper M . Aquaporins in the kidney: from molecules to medicine. Physiol Rev. 2002; 82(1):205-44. DOI: 10.1152/physrev.00024.2001. View

15.

Wong F, Blei A, Blendis L, Thuluvath P . A vasopressin receptor antagonist (VPA-985) improves serum sodium concentration in patients with hyponatremia: a multicenter, randomized, placebo-controlled trial. Hepatology. 2002; 37(1):182-91. DOI: 10.1053/jhep.2003.50021. View

16.

Janicic N, Verbalis J . Evaluation and management of hypo-osmolality in hospitalized patients. Endocrinol Metab Clin North Am. 2003; 32(2):459-81, vii. DOI: 10.1016/s0889-8529(03)00004-5. View

17.

Wong F, Gines P, Watson H, Horsmans Y, Angeli P, Gow P . Effects of a selective vasopressin V2 receptor antagonist, satavaptan, on ascites recurrence after paracentesis in patients with cirrhosis. J Hepatol. 2010; 53(2):283-90. DOI: 10.1016/j.jhep.2010.02.036. View

18.

Gheorghiade M, Niazi I, Ouyang J, Czerwiec F, Kambayashi J, Zampino M . Vasopressin V2-receptor blockade with tolvaptan in patients with chronic heart failure: results from a double-blind, randomized trial. Circulation. 2003; 107(21):2690-6. DOI: 10.1161/01.CIR.0000070422.41439.04. View

19.

Udelson J, Smith W, Hendrix G, PAINCHAUD C, Ghazzi M, Thomas I . Acute hemodynamic effects of conivaptan, a dual V(1A) and V(2) vasopressin receptor antagonist, in patients with advanced heart failure. Circulation. 2001; 104(20):2417-23. DOI: 10.1161/hc4501.099313. View

20.

Decaux G, Vandergheynst F, Bouko Y, Parma J, Vassart G, Vilain C . Nephrogenic syndrome of inappropriate antidiuresis in adults: high phenotypic variability in men and women from a large pedigree. J Am Soc Nephrol. 2007; 18(2):606-12. DOI: 10.1681/ASN.2006090987. View