title: Do vasopressin V2 receptor antagonists benefit cirrhotics with refractory ascites?
abstract: Hyponatremia is a frequent complication of advanced cirrhosis with ascites associated with increased morbidity and mortality. It is caused by an impairment in the renal capacity to eliminate solute-free water and is considered to be related to persistent secretion of vasopressin despite low serum osmolality. This nonosmotic release of vasopressin is mediated by the autonomic nervous system, which senses the underfilling of arterial vascular component. This reduction of effective arterial blood volume is closely related to the development of ascites. Although the short-time effects of vasopressin V2 receptor antagonists (vaptans) on hyponatremia and ascites have been repeatedly reported, their effects on the long-term management of cirrhotic ascites have not been established yet. Considering that their effects on water diuresis and their safety are limited by severe underfilling state of patients, cautious approaches with adequate monitoring are needed to advanced cirrhosis. Proper indication, adequate doses and new possibility of combination therapy should be explored in the future controlled study. As hyponatremia is frequent obstacle to ascites management, judicious combination with low-dose diuretics may decrease the incidence of refractory ascites. Although vaptans show much promise in the treatment of advanced cirrhosis, the problem of high cost should be solved for the future.
authors.affiliation: Hiroshi Fukui, Department of Gastroenterology, Endocrinology and Metabolism, Nara Medical University, Kashihara, Nara 634-8522, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukui
mesh_terms: D000818:Animals; D065092:Antidiuretic Hormone Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D051399:Aquaporin 2 / Q000378:metabolism; D001201:Ascites / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D009481:Neurophysins / Q000097:blood; D018579:Patient Selection; D011498:Protein Precursors / Q000097:blood; D017483:Receptors, Vasopressin / Q000187:drug effects* / Q000378:metabolism; D012307:Risk Factors; D016896:Treatment Outcome; D014667:Vasopressins / Q000097:blood; D014882:Water-Electrolyte Balance / Q000187:drug effects
chemical_list: C496023:AQP2 protein, human; C438657:AVP protein, human; C585768:AVPR2 protein, human; D065092:Antidiuretic Hormone Receptor Antagonists; D051399:Aquaporin 2; D015415:Biomarkers; D009481:Neurophysins; D011498:Protein Precursors; D017483:Receptors, Vasopressin; D014667:Vasopressins
keywords: Ascites; Hyponatremia; Liver cirrhosis; Pathophysiology; V2 receptor antagonist