Hyponatremia in Heart Failure: The Role of Arginine Vasopressin and Diuretics

To provide an overview of the role of arginine vasopressin (AVP) in the development of hyponatremia in patients with heart failure (HF), the role of diuretics, and the potential for vasopressin-receptor antagonists in the treatment of HF. A MEDLINE literature search was performed to identify articles relating to HF, diuretics, hyponatremia, AVP, and vasopressin-receptor antagonists. HF affects more than 5 million patients in the United States and is associated with substantial cost, morbidity, and mortality. One of the complications associated with HF, as well as with its treatment, is the development of hyponatremia. Hyponatremia in patients with HF is associated with poor outcomes and can limit the use of diuretic therapy. AVP is the primary stimulus to the development of hyponatremia in these patients and therapies that target AVP action would seem a logical choice in the therapeutic regimen for HF. Drugs that antagonize the vasopressin V-2 receptor, which is primarily responsible for water resorption in the kidney, are now available and have been studied in patients with HF. These drugs have been associated with improvements in serum sodium concentration, urine output, and body weight, but have shown no long-term mortality benefit in patients with HF. In a subset of patients with baseline hyponatremia, these agents improved quality of life scores. Vasopressin-receptor antagonists may prove useful in the treatment of HF; however, the exact role of these agents in the treatment of HF still requires further study.