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Normoalbuminuric Type 1 Diabetic Patients with Retinopathy Have an Impaired Tubular Response to Desmopressin: Its Relationship with Plasma Endothelin-1

Centro de Investigación Biomédica En Red de Diabetes y Enfermedades Metabólicas (CIBERDEM) (C.H., L.C., M.G.-R., R.S.), Instituto de Salud Carlos III, and the Diabetes Research Unit (C.H., B.R., E.L., L.C., M.G.-R., R.S.), Institut de Recerca Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain

Address all correspondence and requests for reprints to: Dr. Rafael Simó, Diabetes Research Unit, Institut de Recerca Hospital Universitari Vall d’Hebron, Pg. Vall d’Hebron 119-129, 08035 Barcelona, Spain. E-mail: rsimo{at}ir.vhebron.net.

Objective: The aim of the study was to evaluate whether normoalbuminuric type 1 diabetic patients with diabetic retinopathy (DR) have an impaired tubular response to desmopressin (dDAVP, a synthetic analog of vasopressin) administration, and its relationship with plasma and urine endothelin-1 (ET-1) levels.

Design: This was an interventional case-control study.

Setting: The study was conducted at a referral center.

Participants: Fifteen normoalbuminuric type 1 diabetic patients with DR were compared with 30 normoalbuminuric type 1 diabetic patients without DR. Both groups were matched by age, gender, body mass index, glycosylated hemoglobin, and the main laboratory markers of kidney function.

Intervention: After a 12-h period of water deprivation, dDAVP (0.3 µg/kg) was infused over 20 min. Urine was collected at baseline and 1, 2, and 3 h after dDAVP administration. ET-1 was assessed by ELISA.

Results: dDAVP induced a lower rise in urine osmolality in patients with DR (from 650 ± 206 to 754 ± 224 mosmol/kg; P = 0.02) than in diabetic patients without DR (from 714 ± 194 to 905 ± 163 mosmol/kg; P < 0.0001). In addition, fractional excretion of Na⁺ decreased in patients without DR (from 0.45 ± 0.30 to 0.29 ± 0.29%; P = 0.04) but not in the diabetic patients with DR (from 0.36 ± 0.22 to 0.36 ± 0.40%; P = 0.96). Plasma ET-1 levels were inversely correlated with the response of urinary osmolality after dDAVP administration (r = –0.62; P = 0.008).

Conclusions: Normoalbuminuric type 1 diabetic patients with DR have impaired renal response to dDAVP that is related to plasma ET-1 levels. Further studies are required to elucidate whether this tubular resistance to dDAVP might favor dehydration in these patients.