Conivaptan increases serum sodium in hyponatremic patients with end-stage liver disease.
Hyponatremia is associated with increased mortality in patients with end-stage liver disease and a greater risk of perioperative mortality with liver transplantation. We performed a retrospective review of our experience with conivaptan as a means of acutely increasing serum sodium in end-stage liver disease patients. The primary group consisted of 15 patients with end-stage liver disease who remained hyponatremic despite discontinuation of diuretics and a 1-L fluid restriction. Twenty milligrams of conivaptan was intravenously administered over 30 minutes, and this was followed by an infusion of 20 mg over 24 hours for 1 to 4 days. A second group of 9 hyponatremic end-stage liver disease patients was treated with 1-L fluid restriction and conivaptan while remaining on diuretics. In the group without diuretics, the mean serum sodium was 124 mmol/L 1 day before and on the day of conivaptan initiation, but the serum sodium rose to a mean of 127.7 mmol/L by day 1 and further increased to 128.6 mmol/L by the second day of the infusion. Despite the continuation of diuretics, the second group of 9 patients also had an increase in serum sodium from the day of conivaptan initiation (125.7 mmol/L) to 2 days after the treatment (130.6 mmol/L). Eleven patients underwent successful liver transplantation, 2 remained on the list for transplantation, and 11 were not candidates for transplantation and either died (7) or were discharged home and lost to follow-up (4). In conclusion, a short course of conivaptan increases serum sodium in patients with end-stage liver disease and may reduce the risk of proceeding to liver transplantation. Further study in a prospective clinical trial is needed to confirm safety and efficacy.
O'Leary
Jacqueline G
JG
Division of Hepatology, Department of Medicine, Baylor University Medical Center, Dallas, TX 75246, USA. jacquelo@baylorhealth.edu
Davis
Gary L
GL
D000328:Adult; D000368:Aged; D001552:Benzazepines / Q000494:pharmacology*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000097:blood* / Q000188:drug therapy*; D017093:Liver Failure / Q000188:drug therapy* / Q000473:pathology*; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012964:Sodium / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome
D001552:Benzazepines; C106389:conivaptan; D012964:Sodium