Aquaretics in cirrhotics with hyponatremia

Abstract   Hyponatremia develops spontaneously or following diuretic therapy in about one-third of patients with cirrhosis. The development of hyponatremia leads to fluid restriction which is unpopular with patients and limits the usefulness of diuretics. The principle factor that leads to hyponatremia in the cirrhotic is an increase in the non-osmotic release of arginine vasopressin (AVP) and subsequent impaired clearance of free water by the kidney. The development of vasopressin receptor antagonists and Κ-opioid agonists has led to trials examining their efficacy in the treatment of hyponatremia in cirrhosis. The vasopressin receptor antagonists have been shown to improve free water clearance and raise serum sodium in decompensated cirrhotics in short-term studies. The utility of these agents for the long-term management of hyponatremia and in preventing the development of hyponatremia associated with diuretic usage remains to be determined.