PLASMA COPEPTIN levels can be used as an independent marker for the development of kidney diseases, including chronic kidney disease (CKD). Elevated copeptin, as a measure of vasopressin (VP), was significantly associated with an increased risk of kidney damage in a recent study of the general population in Sweden, offering a potential method of detecting high-risk renal patients in the future.
A research group from Skåne University Hospital, Lund University, Lund, Sweden, used two cohorts of Swedish individuals to investigate the relationship between baseline copeptin and kidney disease; the Malmo Preventive Project (MMP) reinvestigated 5,158 individuals and the Malmo Diet and Cancer Cardiovascular Cohort (MDC-CC) of 5,162 participants. The team noted that 89 patients in the MMP and 180 in the MCP-CC with glomerular filtration rates >60 mL/min/1.73 m2 developed CKD during follow-up of 8.7 years and 19.6 years, respectively. In addition, 118 and 213 patients were diagnosed with a second renal disease in the MMP and MDC-CC groups, respectively.
Multivariate analysis revealed that the risk of CKD increased significantly by 46% in the MPP cohort and by 24% in participants from the MDC-CC with each standard deviation increment in Ln-transformed copeptin, even after adjusting for CKD risk factors and other variables. Additionally, there was a significantly greater risk (31%) of patients in the MPP cohort developing other kidney diseases. In a subsequent meta-analysis, the researchers concluded that one standard deviation increment in Ln-transformed copeptin correlated with a significant 18% greater risk of kidney diseases, highlighting the usefulness of copeptin as a predictor of renal disease.
Sofia Enhörning, Skåne University Hospital, commented on the applicability of measuring copeptin levels: “In selected groups of patients, copeptin may in the future assist in detection of individuals that are at higher risk for developing renal diseases and its cardiovascular complications, and who might benefit from preventive therapy such as hydration and pharmacological blockade of the vasopressin system.”
It remains to be discovered how elevated VP leads to CKD, however the team speculated that it may involve new-onset metabolic disease due to the link between elevated copeptin levels and diabetes and hypertension shown in previous studies. However, no significant relationship between diabetes status and copeptin-associated CKD risk was observed, which led the team to believe that mechanisms such as VP-induced hyperfiltration are also involved in the development of kidney damage. Further research is required, but analysis of copeptin levels could prove to be a powerful predictor of kidney damage in the future.