TY - JOUR
T1 - Effects of terlipressin on the aquaretic system: evidence of antidiuretic effects.
AU - Krag, Aleksander
AU - Bendtsen, Flemming
AU - Pedersen, Erling Bjerregaard
AU - Holstein-Rathlou, Niels-Henrik
AU - Møller, Søren
PY - 2008
Y1 - 2008
N2 - The vasopressin analog terlipressin is believed to cause vasoconstriction selectively by V(1) receptor stimulation. However, a possible antidiuretic effect by V(2) receptor stimulation has never been ruled out. Twenty-two patients with ascites, including seven with refractory ascites, were included. The subjects were studied during a 400 ml/h oral water load before and after infusion of 2 mg of terlipressin (18 patients) or placebo infusion (4 patients). Effects on the V(2) receptors were assessed by evaluating aquaporin (AQP)2 excretion, free water clearance (C(H(2)O)), urine osmolality (U(osm)), and fractional distal water excretion (DFeH(2)O). After terlipressin the excretion of AQP2 increased by 89% [144 ng/mmol creatinine, 95% confidence interval (CI) 73-214 ng/mmol creatinine, P = 0.001]. C(H(2)O) decreased 1.05 ml/min (from 0.17 to -0.89 ml/min, P = 0.001), and DFeH(2)O decreased 37% (19 vs. 12; 95% CI 2-11, P = 0.01). U(osm) increased by 27% (93 mosmol/kgH(2)O, 95% CI 23-164 mosmol/kgH(2)O, P = 0.02). Plasma sodium decreased 1.1 mmol/l (P < 0.01). An increase in AQP2 excretion and a decrease in C(H(2)O) and distal water excretion after terlipressin despite water loading is a clear indication of activation of the antidiuretic system (V(2) receptor effect).
AB - The vasopressin analog terlipressin is believed to cause vasoconstriction selectively by V(1) receptor stimulation. However, a possible antidiuretic effect by V(2) receptor stimulation has never been ruled out. Twenty-two patients with ascites, including seven with refractory ascites, were included. The subjects were studied during a 400 ml/h oral water load before and after infusion of 2 mg of terlipressin (18 patients) or placebo infusion (4 patients). Effects on the V(2) receptors were assessed by evaluating aquaporin (AQP)2 excretion, free water clearance (C(H(2)O)), urine osmolality (U(osm)), and fractional distal water excretion (DFeH(2)O). After terlipressin the excretion of AQP2 increased by 89% [144 ng/mmol creatinine, 95% confidence interval (CI) 73-214 ng/mmol creatinine, P = 0.001]. C(H(2)O) decreased 1.05 ml/min (from 0.17 to -0.89 ml/min, P = 0.001), and DFeH(2)O decreased 37% (19 vs. 12; 95% CI 2-11, P = 0.01). U(osm) increased by 27% (93 mosmol/kgH(2)O, 95% CI 23-164 mosmol/kgH(2)O, P = 0.02). Plasma sodium decreased 1.1 mmol/l (P < 0.01). An increase in AQP2 excretion and a decrease in C(H(2)O) and distal water excretion after terlipressin despite water loading is a clear indication of activation of the antidiuretic system (V(2) receptor effect).
U2 - 10.1152/ajprenal.90407.2008
DO - 10.1152/ajprenal.90407.2008
M3 - Journal article
C2 - 18753292
SN - 1931-857X
VL - 295
SP - F1295-300
JO - American Journal of Physiology: Renal Physiology
JF - American Journal of Physiology: Renal Physiology
IS - 5
ER -