Ascites and hyponatremia are the most common complications in patients with liver cirrhosis and develop as a consequence of a severe impairment of liver function and portal hypertension. Increasing evidences support t...Ascites and hyponatremia are the most common complications in patients with liver cirrhosis and develop as a consequence of a severe impairment of liver function and portal hypertension. Increasing evidences support the central role of renal function alterations in the pathogenesis of hydroelectrolytic imbalances in cirrhotic patients, thus implying a dense cross-talk between liver and kidney in the systemic and splanchnic vascular homeostasis in such subjects. Since Arginin Vasopressin(AVP) hyperincretion occurs at late stage of cirrhosis and plays an important role in the development of refractory ascites, dilutional hyponatremia and finally hepato-renal syndrome, selective antagonists of AVP receptors V2(vaptans) have been recently introduced in the therapeutic algorithm of advanced cirrhotic patients. Despite the promising results of earlier phasetwo studies, randomized controlled trials failed to find significant results in terms of efficacy of such drugs both in refractory ascites and hyponatremia. Moreover, concerns on their safety profile arise, due to the number of potentially severe side effects of vaptans in the clinical setting, such as hypernatremia, dehydration, renal impairment, and osmotic demyelination syndrome. More robust data from randomized controlled trials are needed in order to confirm the potential role of vaptans in the management of advanced cirrhotic patients.展开更多
Congestive heart failure(CHF) is one of the most common reasons for hospitalization in the United States. Despite multiple different beneficial medications for the treatment of chronic CHF, there are no therapies with...Congestive heart failure(CHF) is one of the most common reasons for hospitalization in the United States. Despite multiple different beneficial medications for the treatment of chronic CHF, there are no therapies with a demonstrated mortality benefit in the treatment of acute decompensated heart failure. In fact, studies of inotropes used in this setting have demonstrated more harm than good. Arginine vasopressin has been shown to be up regulated in CHF. When bound to the V1 a and/or V2 receptors, vasopressin causes vasoconstriction, left ventricular remodeling and free water reabsorption. Recently, two drugs have been approved for use that antagonize these receptors. Studies thus far have indicated that these medications, while effective at aquaresis(free water removal), are safe and not associated with increased morbidity such as renal failure and arrhythmias. Both conivaptan and tolvaptan have been approved for the treatment of euvolemic and hypervolemic hyponatremia. We review the results of these studies in patients with heart failure.展开更多
An adequate balance between electrolytes and clear water is of paramount importance to maintaining physiologic homeostasis.Natremia imbalance and,in particular,hyponatremia is the most frequent electrolyte abnormality...An adequate balance between electrolytes and clear water is of paramount importance to maintaining physiologic homeostasis.Natremia imbalance and,in particular,hyponatremia is the most frequent electrolyte abnormality observed in hospitalized subjects,involving approximately one-fourth of them.Pathological changes occurring during liver cirrhosis predispose patients to an increased risk of sodium imbalance,and hypervolemic hyponatremia has been reported in nearly 50%of subjects with severe liver disease and ascites.Splanchnic vasodilatation,portal-systemic collaterals’opening and increased excretion of vasoactive modulators are all factors impairing clear water handling during liver cirrhosis.Of concern,sodium imbalance has been consistently reported to be associated with increased risk of complications and reduced survival in liver disease patients.In the last decades clinical interest in sodium levels has been also extended in the field of liver transplantation.Evidence that[Na+]in blood is an independent risk factor for in-list mortality led to the incorporation of sodium value in prognostic scores employed for transplant priority,such as model for end-stage liver disease-Na and UKELD.On the other hand,severe hyponatremic cirrhotic patients are frequently delisted by transplant centers due to the elevated risk of mortality after grafting.In this review,we describe in detail the relationship between sodium imbalance and liver cirrhosis,focusing on its impact on peritransplant phases.The possible therapeutic approaches,in order to improve transplant outcome,are also discussed.展开更多
Hyponatraemia is a common complication of advanced cirrhosis related to an impairment in the renal capacity for eliminating solute-free water,causing a retention of water that is disproportionate to the retention of s...Hyponatraemia is a common complication of advanced cirrhosis related to an impairment in the renal capacity for eliminating solute-free water,causing a retention of water that is disproportionate to the retention of sodium,thus leading to a reduction in serum sodium concentration and hypo-osmolality.The main pathogenic factor responsible for hyponatraemia is a non-osmotic hypersecretion of arginine vasopressin(AVP)or antidiuretic hormone from the neurohypophysis,related to circulatory dysfunction.Hyponatraemia in cirrhosis is associated with increased morbidity and mortality.Hyponatraemia is also associated with increased morbidity and impaired short-term survival after transplantation.The current standard of care based on restricting fluids to 1-1.5 L/day is rarely effective.Other approaches,such as albumin infusion and the use of vaptans—which act by specifically antagonizing the effects of AVP on the V2 receptors located in the kidney tubules—have been evaluated for their role in the management of hyponatraemia.The short-term treatment with vaptans is associated with a marked increase in renal solute-free water excretion and improvement of hyponatraemia;however their use in patients with end-stage liver disease is limited by hepatotoxic effects of some of these drugs.Longterm administration of vaptans seems to be effective in maintaining the improvement of serum sodium concentration,but the available information is still limited.展开更多
文摘Ascites and hyponatremia are the most common complications in patients with liver cirrhosis and develop as a consequence of a severe impairment of liver function and portal hypertension. Increasing evidences support the central role of renal function alterations in the pathogenesis of hydroelectrolytic imbalances in cirrhotic patients, thus implying a dense cross-talk between liver and kidney in the systemic and splanchnic vascular homeostasis in such subjects. Since Arginin Vasopressin(AVP) hyperincretion occurs at late stage of cirrhosis and plays an important role in the development of refractory ascites, dilutional hyponatremia and finally hepato-renal syndrome, selective antagonists of AVP receptors V2(vaptans) have been recently introduced in the therapeutic algorithm of advanced cirrhotic patients. Despite the promising results of earlier phasetwo studies, randomized controlled trials failed to find significant results in terms of efficacy of such drugs both in refractory ascites and hyponatremia. Moreover, concerns on their safety profile arise, due to the number of potentially severe side effects of vaptans in the clinical setting, such as hypernatremia, dehydration, renal impairment, and osmotic demyelination syndrome. More robust data from randomized controlled trials are needed in order to confirm the potential role of vaptans in the management of advanced cirrhotic patients.
文摘Congestive heart failure(CHF) is one of the most common reasons for hospitalization in the United States. Despite multiple different beneficial medications for the treatment of chronic CHF, there are no therapies with a demonstrated mortality benefit in the treatment of acute decompensated heart failure. In fact, studies of inotropes used in this setting have demonstrated more harm than good. Arginine vasopressin has been shown to be up regulated in CHF. When bound to the V1 a and/or V2 receptors, vasopressin causes vasoconstriction, left ventricular remodeling and free water reabsorption. Recently, two drugs have been approved for use that antagonize these receptors. Studies thus far have indicated that these medications, while effective at aquaresis(free water removal), are safe and not associated with increased morbidity such as renal failure and arrhythmias. Both conivaptan and tolvaptan have been approved for the treatment of euvolemic and hypervolemic hyponatremia. We review the results of these studies in patients with heart failure.
文摘An adequate balance between electrolytes and clear water is of paramount importance to maintaining physiologic homeostasis.Natremia imbalance and,in particular,hyponatremia is the most frequent electrolyte abnormality observed in hospitalized subjects,involving approximately one-fourth of them.Pathological changes occurring during liver cirrhosis predispose patients to an increased risk of sodium imbalance,and hypervolemic hyponatremia has been reported in nearly 50%of subjects with severe liver disease and ascites.Splanchnic vasodilatation,portal-systemic collaterals’opening and increased excretion of vasoactive modulators are all factors impairing clear water handling during liver cirrhosis.Of concern,sodium imbalance has been consistently reported to be associated with increased risk of complications and reduced survival in liver disease patients.In the last decades clinical interest in sodium levels has been also extended in the field of liver transplantation.Evidence that[Na+]in blood is an independent risk factor for in-list mortality led to the incorporation of sodium value in prognostic scores employed for transplant priority,such as model for end-stage liver disease-Na and UKELD.On the other hand,severe hyponatremic cirrhotic patients are frequently delisted by transplant centers due to the elevated risk of mortality after grafting.In this review,we describe in detail the relationship between sodium imbalance and liver cirrhosis,focusing on its impact on peritransplant phases.The possible therapeutic approaches,in order to improve transplant outcome,are also discussed.
文摘Hyponatraemia is a common complication of advanced cirrhosis related to an impairment in the renal capacity for eliminating solute-free water,causing a retention of water that is disproportionate to the retention of sodium,thus leading to a reduction in serum sodium concentration and hypo-osmolality.The main pathogenic factor responsible for hyponatraemia is a non-osmotic hypersecretion of arginine vasopressin(AVP)or antidiuretic hormone from the neurohypophysis,related to circulatory dysfunction.Hyponatraemia in cirrhosis is associated with increased morbidity and mortality.Hyponatraemia is also associated with increased morbidity and impaired short-term survival after transplantation.The current standard of care based on restricting fluids to 1-1.5 L/day is rarely effective.Other approaches,such as albumin infusion and the use of vaptans—which act by specifically antagonizing the effects of AVP on the V2 receptors located in the kidney tubules—have been evaluated for their role in the management of hyponatraemia.The short-term treatment with vaptans is associated with a marked increase in renal solute-free water excretion and improvement of hyponatraemia;however their use in patients with end-stage liver disease is limited by hepatotoxic effects of some of these drugs.Longterm administration of vaptans seems to be effective in maintaining the improvement of serum sodium concentration,but the available information is still limited.
