Published online Nov 27, 2014. doi: 10.4254/wjh.v6.i11.793
Revised: September 9, 2014
Accepted: October 1, 2014
Published online: November 27, 2014
Core tip: Increasing evidences support the central role of renal function alterations in the pathogenesis of hydroelectrolytic imbalances in cirrhotic patients. Since Arginin Vasopressin (AVP) plays an important role in the development of refractory ascites, dilutional hyponatremia and hepato-renal syndrome, selective antagonists of AVP receptors V2 (vaptans) have been recently introduced in the therapeutic algorithm of advanced cirrhotic patients. Despite the promising results of earlier phase-two studies, randomized controlled trials failed to find significant results in terms of efficacy. Moreover, concerns on their safety profile arise. More robust data from randomized controlled trials are needed.