Ettema Esmée M, Heida Judith, Casteleijn Niek F, Boesten Lianne, Westerhuis Ralf, Gaillard Carlo A J M, Gansevoort Ron T, Franssen Casper F M, Zittema Debbie
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Laboratory Medicine, IJsselland Hospital, Capelle aan den IJssel, the Netherlands.
Kidney Int Rep. 2017 Jan 23;2(3):410-419. doi: 10.1016/j.ekir.2017.01.006. eCollection 2017 May.
Copeptin is increasingly used in epidemiological studies as a substitute for vasopressin. The effect of renal function on copeptin and vasopressin concentrations as well as their ratio have, however, not been well described.
Copeptin and vasopressin levels were measured in 127 patients with various stages of chronic kidney disease, including 42 hemodialysis patients and 16 healthy participants in this observational study. Linear (segmental) regression analyses were performed to assess the association between renal function and copeptin, vasopressin and the C/V ratio. In addition, clearance of copeptin and vasopressin by hemodialysis was calculated.
Both copeptin and vasopressin levels were higher when renal function was lower, and both showed associations with plasma osmolality. The C/V ratio was stable across renal function in subjects with an eGFR >28 ml/min per 1.73 m. In contrast, the C/V ratio increased with worsening renal function in patients with eGFR ≤28 ml/min per 1.73 m. During hemodialysis, the initial decrease in vasopressin levels was greater compared with copeptin and, consequently, the C/V ratio increased. This was, at least in part, explained by a greater dialytic clearance of vasopressin compared with copeptin.
Our data indicate that copeptin is a reliable substitute for vasopressin in subjects with an eGFR >28 ml/min per 1.73 m, whereas at an eGFR ≤28 ml/min per 1.73 m, that is, CKD stages 4 and 5, a correction for renal function is required in epidemiological studies that use copeptin as a marker for vasopressin. Intradialytic copeptin levels do not adequately reflect vasopressin levels because vasopressin clearance by hemodialysis is higher than that of copeptin.
copeptin在流行病学研究中越来越多地被用作血管加压素的替代物。然而，肾功能对copeptin和血管加压素浓度及其比值的影响尚未得到充分描述。
在这项观察性研究中，对127例不同阶段慢性肾脏病患者（包括42例血液透析患者）和16名健康参与者测定了copeptin和血管加压素水平。进行线性（分段）回归分析以评估肾功能与copeptin、血管加压素及C/V比值之间的关联。此外，计算了血液透析对copeptin和血管加压素的清除率。
肾功能较低时，copeptin和血管加压素水平均较高，且二者均与血浆渗透压相关。估算肾小球滤过率（eGFR）>28 ml/（min·1.73 m²）的受试者中，C/V比值在不同肾功能状态下保持稳定。相反，eGFR≤28 ml/（min·1.73 m²）的患者中，C/V比值随肾功能恶化而升高。血液透析期间，血管加压素水平的初始下降幅度大于copeptin，因此C/V比值升高。这至少部分是由于血管加压素的透析清除率高于copeptin。
我们的数据表明，对于eGFR>28 ml/（min·1.73 m²）的受试者，copeptin是血管加压素的可靠替代物；而对于eGFR≤28 ml/（min·1.73 m²），即慢性肾脏病4期和5期的患者，在使用copeptin作为血管加压素标志物的流行病学研究中，需要对肾功能进行校正。透析期间copeptin水平不能充分反映血管加压素水平，因为血液透析对血管加压素的清除率高于copeptin。
Zotero 插件
