In the Journals

Elevated copeptin associated with atherosclerosis, kidney disease in type 1 diabetes

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April 22, 2016

In adults with type 1 diabetes, elevated copeptin is associated with atherosclerosis and diabetic kidney disease, according to findings in a cross-sectional study.

Petter Bjornstad, MD, a clinical research fellow in pediatric diabetes and endocrinology at Children's Hospital Colorado and the Barbara Davis Center for Childhood Diabetes, and colleagues analyzed data from 453 adults with and without type 1 diabetes and no cardiovascular disease at baseline (2000-2002) participating in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study (209 with diabetes). Researchers measured serum copeptin, coronary artery calcium (CAC) via CT, urinary albumin-to-creatinine ratio and estimated glomerular filtration rate at baseline and 3, 6 and 12 years.

Petter Bjornstad

Researchers defined impaired GFR as eGFR less than 60 mL/min/1.73 m2, albuminuria as urinary albumin-to-creatinine ratio of at least 30 mg/g, high and very high CAC score as at least 100 Agatston units and at least 300 Agatston units, respectively, and elevated copeptin as more than 13 pmol/L (> 97.5th percentile for healthy adults). Researchers used logistic regression analyses to evaluate the relationships between copeptin, albuminuria, impaired GFR and high and very high CAC.

Participants with type 1 diabetes had greater ultrasensitive copeptin concentrations than participants without diabetes (3.5 pmol/L vs. 2.8 pmol/L; P = .003); differences persisted after adjusting for age, sex and eGFR (3.6 pmol/L vs. 2.9 pmol/L; P = .0008).

In participants with type 1 diabetes, elevated copeptin was associated with greater odds of impaired eGFR (OR = 18.52; 95% CI, 4.03-85.02), albuminuria (OR = 10.55; 95% CI, 2.24-49.62), high CAC (OR = 6.61; 95% CI, 1.39-31.31) and very high CAC (OR = 6.24; 95% CI, 1.51-25.9) in multivariable models. Researchers observed similar linear relationships with ultrasensitive copeptin, eGFR, urinary albumin-to-creatinine ratio, CAC volume and CAC score in adjusted models.

“If our cross-sectional findings hold true in longitudinal studies, copeptin may become an important biomarker in predicting vascular complications in type 1 diabetes,” Bjornstad told Endocrine Today. “Furthermore, vasopressin is a modifiable risk factor and, therefore, a promising therapeutic target. Vasopressin pathway can be modified by lifestyle changes (eg, drinking more water) and medications (eg, vaptans).

“Studies are needed to evaluate whether the relationships between copeptin, diabetic kidney disease and atherosclerosis hold true longitudinally and whether these associations imply causality,” Bjornstad said. by Regina Schaffer

For more information:

Petter Bjornstad, MD, can be reached at the Barbara Davis Center for Childhood Diabetes at the University of Colorado, Denver, 1775 Aurora Court, Aurora, CO 80045; email:

Disclosure: Bjornstad reports no relevant financial disclosures.