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International Journal of Nephrology
Volume 2011 (2011), Article ID 732746, 7 pages
http://dx.doi.org/10.4061/2011/732746
Review Article

Hyponatremia and Congestive Heart Failure: A Marker of Increased Mortality and a Target for Therapy

1Divsions of Nephrology and Critical Care, University of Alberta, Edmonton, AB, Canada T6G 2G3
2Division of Critical Care, University of Alberta, Edmonton, AB, Canada T6G 2G3
3Divsion of Nephrology, University of Virginia Health System, Charlottesville, Box 800133, VA 22911, USA

Received 2 August 2010; Accepted 23 February 2011

Academic Editor: Anjay Rastogi

Copyright © 2011 Adam Romanovsky et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Heart failure is one of the most common chronic medical conditions in the developed world. It is characterized by neurohormonal activation of multiple systems that can lead to clinical deterioration and significant morbidity and mortality. In this regard, hyponatremia is due to inappropriate and continued vasopressin activity despite hypoosmolality and volume overload. Hyponatremia is also due to diuretic use in an attempt to manage volume overload. When hyponatremia occurs, it is a marker of heart failure severity and identifies patients with increased mortality. The recent introduction of specific vasopressin-receptor antagonists offers a targeted pharmacological approach to these pathophysiological derangements. Thus far, clinical trials with vasopressin-receptor antagonists have demonstrated an increase in free-water excretion, improvement in serum sodium, modest improvements in dyspnea but no improvement in mortality. Continued clinical trials with these agents are needed to determine their specific role in the treatment of both chronic and decompensated heart failure.