title: Relationship between impaired aldosterone response to adrenocorticotropic hormone and prevalence of hemodialysis in type 2 diabetic patients without azotemia.
abstract: The present prospective observational study was designed to assess the prevalence of hemodialysis in type 2 diabetic patients with an impairment of plasma aldosterone responsiveness to adrenocorticotropic hormone (ACTH). Sixty seven patients (43 men and 24 women) were selected. The inclusion criteria were age < 65 years; presence of normoalbuminemia (serum albumin > 3.6 g/dl); and absence of azotemia (serum creatinine < or = 1.2 mg/dl in males, and < or = 1.0 mg/dl in females). Soluble alpha(1-24)-ACTH was injected intramuscularly in a single dose of 0.25 mg after overnight recumbency. The area under the aldosterone curve (aldosterone AUC) was calculated. The diabetic patients were divided into two groups according to the levels of aldosterone AUC. Patients with an aldosterone AUC in the range of 0-381 were considered poor responders (n = 31) and those with an AUC of 397-1,007 were considered good responders (n = 36). The follow-up was performed during a 144-month period. The end point of the study was the introduction of hemodialysis. A total of 14 patients (12 poor responders and 2 good responders; p < 0.001) were introduced to hemodialysis. The prevalence of hemodialysis in the poor responders (5.74 per 100 patient-years) was significantly higher (p < 0.001, log-rank test) than that in the good responders (0.68 per 100 patient-years). One possible explanation is that an inappropriate level of salt intake relative to the impaired plasma aldosterone control may have contributed to the high prevalence of risks and hemodialysis in the poor responders.
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Kanazawa Medical University, Ishikawa, Japan. kigoshi@kanazawa-med.ac.jp
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Kigoshi
authors.forename: Keigo
authors.initials: K
authors.lastname: Uehara
authors.forename: Keisuke
authors.initials: K
authors.lastname: Furuya
authors.forename: Kazunori
authors.initials: K
authors.lastname: Konishi
authors.forename: Masataka
authors.initials: M
authors.lastname: Fukuda
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Ito
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishizawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakagawa
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nakano
authors.forename: Kenzo
authors.initials: K
authors.lastname: Uchida
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D000450:Aldosterone / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D014511:Uremia
chemical_list: D000450:Aldosterone; D000324:Adrenocorticotropic Hormone