Hyponatremia by Eric E. Simon

Author:Eric E. Simon
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Disclosure: S.R.G. is a consultant to, speaks for, and has received research support from both Astellas and Otsuka, the makers of conivaptan and tolvaptan, respectively.

Background

A common feature of heart failure (HF) is salt and water retention. Hyponatremia, defined as a serum sodium concentration <135 mmol/L, is a frequent finding in HF patients admitted to the hospital. Hyponatremia is present in 8–27 % of patients as reported in various recent registries and clinical trials [1–4]. Hyponatremia is multifactorial in origin with potential causes including neurohormonal activation, hemodynamic instability, HF-related renal derangement, and possibly therapies applied to treat HF. Most cases of hyponatremia in HF occur with normal or expanded total blood volume and so are due in large part to the presence of excessive levels of the antidiuretic hormone arginine vasopressin (AVP). The presence of hyponatremia clearly correlates with disease severity and outcome. Many models have identified hyponatremia as an independent negative prognostic variable [5, 6]. This relationship is independent of renal function. In this chapter, we will review the importance of hyponatremia in patients with HF as a marker of severity and as a potential target of therapy, as well as the status of the most recent development in therapy for hyponatremia in HF, antagonism of the V2 receptor for AVP.

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