title: Role of vaptans in the management of hydroelectrolytic imbalance in liver cirrhosis.
abstract: 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 phase-two 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.
authors.affiliation: Antonio Facciorusso, Annabianca Amoruso, Viviana Neve, Matteo Antonino, Valentina Del Prete, Michele Barone, Department of Medical Sciences, Section of Gastroenterology University of Foggia, 71100 Foggia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Facciorusso
authors.affiliation: Antonio Facciorusso, Annabianca Amoruso, Viviana Neve, Matteo Antonino, Valentina Del Prete, Michele Barone, Department of Medical Sciences, Section of Gastroenterology University of Foggia, 71100 Foggia, Italy.
authors.forename: Annabianca
authors.initials: A
authors.lastname: Amoruso
authors.affiliation: Antonio Facciorusso, Annabianca Amoruso, Viviana Neve, Matteo Antonino, Valentina Del Prete, Michele Barone, Department of Medical Sciences, Section of Gastroenterology University of Foggia, 71100 Foggia, Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Neve
authors.affiliation: Antonio Facciorusso, Annabianca Amoruso, Viviana Neve, Matteo Antonino, Valentina Del Prete, Michele Barone, Department of Medical Sciences, Section of Gastroenterology University of Foggia, 71100 Foggia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Antonino
authors.affiliation: Antonio Facciorusso, Annabianca Amoruso, Viviana Neve, Matteo Antonino, Valentina Del Prete, Michele Barone, Department of Medical Sciences, Section of Gastroenterology University of Foggia, 71100 Foggia, Italy.
authors.forename: Valentina Del
authors.initials: VD
authors.lastname: Prete
authors.affiliation: Antonio Facciorusso, Annabianca Amoruso, Viviana Neve, Matteo Antonino, Valentina Del Prete, Michele Barone, Department of Medical Sciences, Section of Gastroenterology University of Foggia, 71100 Foggia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Barone
keywords: Arginin vasopressin; Cirrhosis; Liver; Portal hypertension; Vaptans