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NDT Advance Access originally published online on February 13, 2009
Nephrology Dialysis Transplantation 2009 24(5):1371-1373; doi:10.1093/ndt/gfp034
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


The vaptans ante portas: a status report

Peter Gross1, Tadeusz Marczewski2 and Kay Herbrig1

1 Division of Nephrology, Department of Medicine III, Universitätsklinikum Carl Gustav Carus Dresden, Germany 2 Medical University of Lublin, Poland

Correspondence and offprint requests to: Peter Gross, Division of Nephrology, Department of Medicine III, Universitätsklinikum Carl Gustav Carus, Fetscherstrasse 74, D-01307 Dresden, Germany. Tel: +351-458-2645; Fax: +351-458-5333; E-mail: peter.gross@uniklinikum-dresden.de

Keywords: cardiac failure; cerebral salt wasting; hyponatraemia; liver cirrhosis; vasopressin antagonists

The first 150 words of the full text of this article appear below.

On 25 June 2008 the US Food and Drug Administration held a public Advisory Committee Meeting of its Cardiovascular and Renal Drugs Division on Tolvaptan (NDA 22-275), the first oral vasopressin antagonist to apply for licensing (http://www.fda.gov/ohrms/dockets/ac/cder08.html# CardiovascularRenal). Based on the comments made, we may now expect that tolvaptan will make it to the pharmacies soon. Over the last few years, we have been shown repeated evidence that vaptans shall be helpful (and safe) in the treatment of chronic hyponatraemia under most, though not all, circumstances [1,2]. Assuming that this scenario will come true, is it time to lean back and consider the issues surrounding the vaptans resolved? Not really.



   Will it pay to use vaptans?
 
Surprisingly, we do not really know. One publication was able to demonstrate that hyponatraemia was a predictor of (increased) medical costs at 6 and 12 months [3], but this does not necessarily prove that costs will . . . [Full Text of this Article]



   Which hyponatraemias must not be treated with vaptan?
 


   Why are there treatment failures with vaptans?
 


   Do all responders respond equally well?
 


   Are vaptans suitable agents for emergency hyponatraemia?
 


   Should we use vaptans to treat diuretic resistant oedema?
 


   Do vaptans save lives in severe cardiac failure?
 


   Why do vaptans increase thirst?
 


   Miscellaneous
 

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