Corradi Valentina, Martino Francesca, Gastaldon Fiorella, Scalzotto Elisa, Caprara Carlotta, Fortunato Antonio, Pinaffo Giulia, Marchetti Cristina, Fabbi Francesca, Giavarina Davide, Ferrari Fiorenza, Rosner Mitchell H, Ronco Claudio
Clin Nephrol. 2016 Sep;86(9):147-53. doi: 10.5414/CN108894.
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. Studies have suggested a possible prognostic role of copeptin in determining the rate of progressive kidney function decline in ADPKD patients. However, it remains unresolved whether the changes in copeptin levels are specific for ADPKD or merely reflect a decline in glomerular filtration rate (GFR) regardless of the etiology of chronic kidney disease (CKD).
We performed a case-control study in ADPKD and non-ADPKD (control) patients. Patients were categorized based on the GFR-category (G-stage, KDIGO). We evaluated urea, creatinine, cystatin C, and copeptin in plasma and correlated these levels with estimated glomerular filtration rate (eGFR) (CKD-EPI). All p-values were two sided, and p < 0.05 was considered as statistically significant.
We enrolled 112 ADPKD and 112 control patients. The median copeptin level was 10.72 (interquartile range (IQR) 5.21 - 26.21) pmol/L in the ADPKD group and 12.32 (IQR 4.47 - 30.73) pmol/L in the control group. The median copeptin level increased according to the G-stage in a progressive fashion and remained statistically significant across all G-stages and in both groups. Copeptin levels were not significantly different between ADPKD and control groups. We found a significant inverse correlation between copeptin level and eGFR (Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)) in the ADPKD, r = -0.81 (p < 0.001), and in the control group, r = -0.76 (p < 0.001).
Copeptin levels seem to be strongly correlated with renal function rather than the presence of ADPKD. Further prospective studies need to evaluate its role as a prognostic marker in the early stage of CKD for ADPKD progression.
常染色体显性多囊肾病（ADPKD）是最常见的遗传性肾脏疾病。研究表明， copeptin在确定ADPKD患者肾功能进行性下降速率方面可能具有预后作用。然而， copeptin水平的变化是ADPKD所特有的，还是仅仅反映了肾小球滤过率（GFR）的下降（无论慢性肾脏病（CKD）的病因如何），这一问题仍未得到解决。
我们对ADPKD患者和非ADPKD（对照）患者进行了一项病例对照研究。根据GFR类别（G分期，KDIGO）对患者进行分类。我们评估了血浆中的尿素、肌酐、胱抑素C和copeptin，并将这些水平与估计肾小球滤过率（eGFR）（CKD-EPI）进行关联。所有p值均为双侧，p<0.05被认为具有统计学意义。
我们纳入了112例ADPKD患者和112例对照患者。ADPKD组copeptin水平中位数为10.72（四分位间距（IQR）5.21 - 26.21）pmol/L，对照组为12.32（IQR 4.47 - 30.73）pmol/L。copeptin水平中位数根据G分期呈进行性升高，在所有G分期以及两组中均具有统计学意义。ADPKD组和对照组之间copeptin水平无显著差异。我们发现ADPKD组中copeptin水平与eGFR（慢性肾脏病流行病学协作组（CKD-EPI））之间存在显著负相关，r = -0.81（p<0.001），对照组中r = -0.76（p<0.001）。
copeptin水平似乎与肾功能密切相关，而非与ADPKD的存在相关。进一步的前瞻性研究需要评估其作为CKD早期ADPKD进展的预后标志物的作用。
