Hyponatremia to be an excellent predictor of outcome in patients with advanced cirrhosis (original) (raw)

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2005

Abstract

Ruf et al. report hyponatremia to be an excellent predictor of outcome in patients with advanced cirrhosis and that the presence of hyponatremia significantly increases the efficacy of the Model for End-Stage Liver Disease (MELD) to predict waitlist mortality.1 Furthermore, they suggest hyponatremia to be incorporated into the MELD formula. However, we believe that with the emergence of aquaretics (i.e., V2-receptor antagonists) for treatment of hyponatremia these suggestions should be viewed with caution. These drugs, which are expected to be approved by the FDA this year, have been shown to reverse hyponatremia efficiently in patients with advanced liver disease.2,3 While it has yet to be shown that treatment with aquaretics increases survival in this patient population, the prevalence of hyponatremia will certainly decrease with the more widespread use of these drugs. Furthermore, it can be assumed that the management of ascites will also be affected due to the aquaretic effect of these drugs. With the emergence of these new drugs and the anticipated change of the incidence of hyponatremia in this patient population, we believe that the suggestion to incorporate serum sodium into the MELD score might be premature and will need to be reconsidered after the full impact of these drugs have been evaluated. Hendrik Koller, MD Alexander Rosenkranz Department of Nephrology Medical University Innsbruck Innsbruck, Austria

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