Programme no. 351-P
Association between Copeptin and declining glomerular filtration rate in newly diagnosed diabetes patients. The Skaraborg Diabetes Register
Miriam Pikkemaat*1, Olle Melander2, Kristina Bengtsson Boström3
1Department of Clinical Sciences,Center for Primary Health Care Research,Malmö,Sweden;Husensjö Health Care Centre,Helsingborg,Sweden, 2Department of Medicine,Malmö University Hospital,Malmö,Sweden, 3R&D Centre, Skaraborg Primary Care, ,Skövde,Sweden
* = Presenting author
Objectives: The objective of the project was to study copeptin concentrations and the development of the estimated glomerular filtration rate (eGFR) in newly diagnosed patients with diabetes.
Background: Chronic kidney disease (CKD) is a common complication to diabetes. Which individuals have the highest risk to be affected is not known. Early detection could help avoiding complications. Copeptin concentrations have shown association with development of CKD in patients with diabetes although there is limited knowledge of the association in newly diagnosed patients.
Results: From base-line to follow up eGFR decreased with 33 ml. Twenty-nine individuals (18.1%) developed CKD stage 3. There was a significant association between elevated copeptin concentrations and development of CKD stage 3 (HR = 1.78, 95% CI = 1.01-3.16). When adjusting for GFR at baseline the association between copeptin and GFR decline was borderline significant (HR = 1.79, 95% CI = 0.99 – 3.25, p = 0.055).
The study is a longitudinal study (1996 to 2010) of newly diagnosed patients with type 2 diabetes using data from a reinvestigation and from national registers.
Copeptin was determined in individuals with newly diagnosed type 2 diabetes (n=382) from Skaraborg Diabetes Register (SDR). Data on cardiovascular complications were extracted from a national register. Creatinine and cystatin C was used for determination of eGFR at base-line and after 12 years in 161 patients with complete data. Data was analyzed with logistic regression.
Conclusion: The use of copeptin concentration could help identify patients with high risk for CKD early. To prevent complications these patients should be treated aggressively with renal protective agents.
Points for discussion: Previous studies have shown an association between Copeptin and a decrease in eGFR, though none of the studies consisted of newly diagnosed patients with diabetes which is a strength of our study. The findings are especially interesting because the AVP system of which copeptin is a part is potentially modifiable through both pharmacological and non-pharmacological interventions. Further research would be of interest using copeptin as a riskmarker in intervention studies. At the same time we know that multifactorial intensive treatment of high blood pressure, lipids and blood glucose in these patients is beneficial to prevent diabetic nephropathy and to save lives but has to be individualized as it is known that intensive blood glucose lowering therapy in patients with type 2 diabetes does not always reduce mortality and can even increase mortality. Therefore it is beneficial to know which group of patients is at special risk and could profit of a more intensive treatment.