The May eJournalClub of CJASN selection, "Efficacy and Tolerance of Urea Compared with Vaptans for Long-Term Treatment of Patients with SIADH" by Alain Soupart, MD and colleagues
Check it out at http://ejc.cjasn.org/phpBB3/
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Yes, Vaptans are expensive and have not shown to decrease mortality (see EVEREST study). Also there is an intrinsic risk of overcorrection with Vaptans. Several studies in animals have shown that urea is not only effective in correcting serum sodium concentration, but it is cheap and apparently it protects against osmotic demyelination syndrome. Urea has been shown to increase reaccumulation of myoinositol in brain cells. That is why there are a handful of cases of ODS in dialysis patients
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