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Ventricular-Assist Devices and Kidney Disease pp 71–78Cite as

Hyponatremia in Heart Failure and Ventricular Assist Device Patients

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Abstract

Hyponatremia is commonly seen in heart failure (HF) patients and is a poor prognostic marker of HF mortality. The more severe the hyponatremia, the greater the association with poor outcomes. Although hyponatremia can be caused by multiple mechanisms, in HF patients the hyponatremia is most commonly categorized as hypo-osmolal hyponatremia with hypervolemia. The pathogenesis of hyponatremia in HF is due to cardiac dysfunction which results in a reduced glomerular filtration rate and an increase in vasopressin (ADH) secretion. Most HF patients with hyponatremia are asymptomatic and can be managed by limiting water intake and using diuretics. However if the plasma sodium level is <125 mEq/L or if symptoms of hyponatremia are present, then more active management of this electrolyte abnormality is necessary. Diuretics are the principal treatment for both hyponatremia and HF since they result in hypotonic fluid losses. Recently, selective and nonselective vasopressin antagonists have become available. However, despite demonstrated efficacy in producing a water diuresis and a correction of hyponatremia, vasopressin antagonists are not commonly used in HF patients. Vasopression antagonists have not been shown to affect mortality, have some potentially serious adverse reactions, and are costly.

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Authors and Affiliations

  1. Renal Division, Emory University School of Medicine, Atlanta, GA, USA

    Jason Cobb & James L. Bailey

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  1. Jason Cobb
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  2. James L. Bailey
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Correspondence to Jason Cobb .

Editor information

Editors and Affiliations

  1. Director, Nephrology, Solid Organ Transplantation and Advanced Heart Failure Therapies, Advocate Christ Medical Center, University of Illinois, Oak Lawn, Illinois, USA

    Chaitanya Desai

  2. Clinical Associate Professor of Medicine University of Illinois, Clinical Director, Heart Transplantation and Mechanical Assistance, Advocate Christ Medical Center, Oak Lawn, Illinois, USA

    William G. Cotts

  3. Clinical Professor of Medicine, Section of Nephrology, University of Illinois at Chicago, College of Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois, USA

    Edgar V. Lerma

  4. Associate Professor of Medicine, Division of Nephrology, Department of Medicine, Penn Presbyterian Medical Cente, Perleman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Michael R. Rudnick

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Cobb, J., Bailey, J.L. (2018). Hyponatremia in Heart Failure and Ventricular Assist Device Patients. In: Desai, C., Cotts, W., Lerma, E., Rudnick, M. (eds) Ventricular-Assist Devices and Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-74657-9_5

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  • DOI: https://doi.org/10.1007/978-3-319-74657-9_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74656-2

  • Online ISBN: 978-3-319-74657-9

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