• Wendy E Boertien, Esther Meijer, Jie Li, James E Bost, Joachim Struck, Michael F Flessner, Ron T Gansevoort, Vicente E Torres, and Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease CRISP.
• Department of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands.
• Am. J. Kidney Dis. 2013 Mar 1;61(3):420-9.

BackgroundExperimental studies indicate that arginine vasopressin (AVP) may have deleterious effects in the pathogenesis of autosomal dominant polycystic kidney disease (ADPKD). However, the significance of AVP in human ADPKD is unclear.Study DesignLongitudinal observational study with 8.5 (IQR, 7.7-9.0) years' follow-up (CRISP [Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease]).Setting & Participants241 patients with ADPKD with creatinine clearance >70 mL/min.PredictorPlasma copeptin concentration, a surrogate marker for AVP.OutcomesChange in measured glomerular filtration rate (mGFR, assessed by iothalamate clearance) and total kidney volume (measured by magnetic resonance imaging).MeasurementsBaseline copeptin level, plasma and urinary osmolality, and measurements of total kidney volume and mGFR during follow-up.ResultsIn these patients (median age, 34 [IQR, 25-40] years; 38% men; median mGFR, 94 [IQR, 79-145] mL/min/1.73 m(2); median total kidney volume, 859 [IQR, 577-1,299] mL), median copeptin level was 2.9 (IQR, 1.8-5.1) pmol/L. Copeptin was not associated with plasma osmolality (P = 0.3), the physiologic stimulus for AVP release, but was associated significantly with change in total kidney volume during follow-up (P < 0.001). This association remained significant after adjusting for sex, age, cardiovascular risk factors, and diuretic use (P = 0.03). Copeptin level was associated borderline significantly with change in mGFR after adjusting for these variables (P = 0.09).LimitationsNo standardization of hydration status at time of copeptin measurement.ConclusionsThese data show that in ADPKD, copeptin level, as a marker for AVP, is not correlated with plasma osmolality. Most importantly, high copeptin levels are associated independently with disease progression in early ADPKD. This is in line with experimental studies that indicate a disease-promoting role for AVP.Copyright © 2013 National Kidney Foundation, Inc. All rights reserved.

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