Plasma aldosterone concentration in the patient with diabetes mellitus

Kidney Int. 2004 Apr;65(4):1435-9. doi: 10.1111/j.1523-1755.2004.00524.x.

Abstract

Background: Vascular injury at the microvascular and macrovascular levels plays a crucial role in the patient with diabetes mellitus. Evidence for renin-system activation in many patients with type 1 diabetes mellitus has raised the possibility that aldosterone-widely recognized as a contributor to vascular injury-could play a role.

Methods: We examined the state of the renin-angiotensin-aldosterone system (RAAS) in 58 subjects with type 1 diabetes mellitus and 64 age-matched normal control subjects. All studies were performed on a fixed sodium (200 mmol/day) and potassium (100 mmol/day intake), and samples were drawn at 8:00 a.m. to avoid the influence of circadian rhythms.

Results: The patient with diabetes mellitus showed an increase in plasma renin activity (PRA) (P < 0.01), plasma angiotensin II concentration (P < 0.01), and plasma aldosterone concentration (P < 0.001). A striking influence of the angiotensin receptor blocker, candesartan, on plasma aldosterone concentration in the patients with diabetes mellitus suggested strongly that renin-system activation is responsible for the elevated plasma aldosterone concentration.

Conclusion: Pharmacologic interruption of the effects of aldosterone at the tissue level could be especially useful in patients with diabetes mellitus. The dose of agents that block the renin-angiotensin system (RAS) should be adjusted to maximize the fall in plasma aldosterone concentration.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aldosterone / blood*
  • Angiotensin II / blood
  • Angiotensin II Type 1 Receptor Blockers
  • Benzimidazoles / therapeutic use
  • Case-Control Studies
  • Diabetes Mellitus, Type 1 / blood*
  • Diabetes Mellitus, Type 1 / drug therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osmolar Concentration
  • Renin / blood
  • Tetrazoles / therapeutic use

Substances

  • Angiotensin II Type 1 Receptor Blockers
  • Benzimidazoles
  • Tetrazoles
  • Angiotensin II
  • Aldosterone
  • Renin
  • candesartan