Plasma copeptin as a predictor of kidney disease

Sofia Enhörning, Anders Christensson, Olle Melander, Sofia Enhörning, Anders Christensson, Olle Melander

Abstract

Background: Plasma copeptin, a marker of vasopressin, is associated with renal function decline in the general population. Our aim was to study the links between elevated copeptin and future risk of kidney disease.

Methods: Copeptin was measured in a sample of the Malmö Preventive Project (MPP) Reinvestigation (n = 5158) and in the Malmö Diet and Cancer Cardiovascular Cohort (MDC-CC) (n = 5162). According to national registers, 89 subjects in MPP and 180 in MDC-CC developed chronic kidney disease (CKD) during follow-up (8.7 and 19.6 years, respectively).

Results: After multivariate adjustment (gender, age, body mass index, smoking status, estimated glomerular filtration rate, prevalent diabetes, systolic blood pressure and prevalent antihypertensive treatment), copeptin (beta-coefficient per 1 standard deviation increment of ln copeptin) was independently associated with increased risk of CKD during follow-up in both cohorts (MPP: (HR) 1.46, 95% confidence interval (CI) 1.18-1.80, P < 0.001; MDC-CC: HR 1.25, 95% CI 1.02-1.54, P = 0.03) among subjects free from prevalent kidney disease at baseline. Furthermore, in MPP, elevated copeptin predicted a specified diagnosis of kidney disease other than CKD (HR 1.31, 95% CI 1.08-1.59, P = 0.006) after multivariate adjustment. In a corresponding analysis in MDC-CC, copeptin was associated with a 10% increased risk, which, however, was non-significant (P = 0.25). A meta-analysis of the MPP and MDC-CC data showed significant association between elevated copeptin and a specified diagnosis of kidney disease other than CKD (HR 1.18, 95% CI 1.05-1.34, P = 0.008).

Conclusion: An increased level of copeptin independently predicts development of both CKD and other specified kidney diseases, suggesting that copeptin can be used to identify individuals at risk for kidney disease development.

Figures

FIGURE 1
FIGURE 1
Meta-analysis of the MPP and MDC-CC data on the association between copeptin (beta-coefficient per 1 SD increment of ln copeptin) and CKD development (A) and Meta-analysis of the MPP and MDC-CC data on the association between copeptin (beta-coefficient per 1 SD increment of ln copeptin) and development of specified kidney disease other than CKD (B).
FIGURE 2
FIGURE 2
Increased risk of CKD diagnosis in the highest tertile of copeptin in MPP (A) and MDC-CC (B), among subjects without diagnosis of prevalent kidney disease and with baseline eGFR (CKD-EPI 2009) ≥60 mL/min/1.73 m2. Cases of specified kidney disease are censored.
FIGURE 3
FIGURE 3
Increased risk of specified kidney diseases in the highest tertile of copeptin in MPP (A) and MDC-CC (B), among subjects without diagnosis of prevalent kidney disease and with baseline eGFR (CKD-EPI 2009) ≥60 mL/min/1.73 m2. Cases of CKD are censored.

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