SP271IS REDUCTION IN AVP LEVLES BY HYDROTHERAPY EFFECTIVE IN REDUCING URINARY ALBUMIN EXCRETION?

Abstract

INTRODUCTION AND AIMS: Copeptin is a part of pro-AVP released with Arginine vasopressin(AVP). Copeptin analysis is an alternative to AVP measurement. This study is attempted to demonstrate reduction of plasma AVP levels after a period of hydration and to assess its translation to reduced urinary albumin excretion in early stages of CKD. i)To compare: Baseline copeptin levels in the plasma of various study groups 1)normal individuals 2)Type 2 diabetes mellitus patients with microalbuminuria 3)patients with systemic hypertension ii)To assess the change in plasma copeptin values after a self monitored water load in the above groups iii)To assess the change in proteinuria after this period of water load METHODS: Comparative cross sectional study. Duration:1year. 90 male patients were selected from the clinic and grouped into 3. Inclusion criteria Group 1 30 healthy subjects in the same age group who met the following criteria 1.No history of diabetes 2.BMI<28kg/m2 3.No hypertension 4.Not on any long term drugs 5.No dyslipidemia, no history of cardiovascular events 6.Non smoker, non alcoholic 7.No history of renal disease Group 2 25 male Type 2 diabetes patients on oral hypoglycemic agents with moderately increased albuminuria in the age group 18-40 years with i)well controlled diabetes ii) Moderately increased albuminuria. All patients were on ACEI/ARBs Group 3 25 male patients with hypertension and moderately increased albuminuria in the age group 18-40 yrs Exclusion Criteria i) No written consent ii) subjects<18 or>40 years iii) subjects with accelerated hypertension during study iv)abnormal baseline osmolality levels v)advanced diabetic kidney disease vi)systolic BP>180mmHg and diastolic BP>110 mmHg vii)other intercurrent illness. 80 male subjects were studied. Baseline glycemic control status, albuminuria, plasma osmolality, plasma copeptin, S. uric acid levels were assessed. Participants were instructed to maintain a high hydration state by taking 2-2.5L of free water daily for the next 3months and to avoid caffeine and smoking. At the end of 3 months subjects were reassessed. RESULTS: Observations at the baseline suggested a higher plasma osmolality and copeptin levels in group2 and 3. One way ANOVA applied to the groups proved the difference in copeptin and S. osmolality at baseline to be statistically significant. CONCLUSIONS: 1.Baseline plasma osmolality and copeptin levels were higher in patients with diabetes and hypertension 2.There is definite reduction in S.AVP levels and plasma osmolality levels after adequate fluid intake 3.There is significant reduction in urinary albumin excretion and copeptin levels with proper hydration 4.Correlation between reduction in albuminuria and reduced copeptin levels could not demonstrated in this study, though individually they showed significant reduction post hydration (Table presented).