Use of Vaptans Is Not Recommended for Hyponatremia in Cirrhosis

In patients with cirrhosis, hemodynamic changes lead to increased secretion of arginine vasopressin, which results in water retention and dilutional hyponatremia. Vaptans (nonpeptide vasopressin receptor antagonists) promote increased free water clearance with hypotonic dieresis. Although vaptans are approved for use in hyponatremic patients, their efficacy and safety in patients with cirrhosis is debated.

Now, investigators have conducted a systematic review and meta-analysis of 12 industry-funded, randomized, controlled trials that evaluated the safety and efficacy of vaptans (tolvaptan, satavaptan, and lixivaptan) in patients with cirrhosis and hyponatremia or ascites. Of 2266 total participants, 1483 received vaptans, and 783 controls re…