Although low dietary salt intake has beneficial effects on BP (blood pressure), low 24hUNa (24 h urinary sodium excretion), the most accurate estimate of dietary salt intake, is associated with increased mortality in people with diabetes. In the non-diabetic population, low salt intake is associated with increased RAAS (renin–angiotensin–aldosterone system) activity. In this cross-sectional study, we examined the relationship between 24hUNa, PRA (plasma renin activity), serum aldosterone and BNP (brain natriuretic peptide) in patients with diabetes. Clinical characteristics, 24hUNa, PRA, serum aldosterone and BNP were recorded in 222 consecutive patients (77% with Type 2 diabetes) attending a diabetes clinic at a tertiary hospital. The relationship between 24hUNa, serum aldosterone, PRA, BNP, urinary potassium excretion, serum potassium, serum sodium, eGFR (estimated glomerular filtration rate), urinary albumin excretion and HbA1c (glycated haemoglobin) was examined by a multivariable regression model. Levels of 24hUNa significantly predicted serum aldosterone in a linear fashion (R2=0.20, P=0.002). In the subgroup of patients (n=46) not taking RAAS-modifying agents, this relationship was also observed (R2=0.10, P=0.03), and the effect of 24hUNa on serum aldosterone was found to be more pronounced than in the whole cohort (coefficient=−0.0014, compared with −0.0008). There was no demonstrable relationship between 24hUNa and PRA or BNP. Low 24hUNa is associated with increased serum aldosterone in people with diabetes, in the presence and absence of RAAS-modifying agents. This raises the possibility that stimulation of the RAAS may be a mechanism that contributes to adverse outcomes observed in patients with low 24hUNa.
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Research Article|
September 19 2013
Relationship between urinary sodium excretion and serum aldosterone in patients with diabetes in the presence and absence of modifiers of the renin–angiotensin–aldosterone system
Renata Libianto;
Renata Libianto
*Department of Medicine, Austin Health and the University of Melbourne, Melbourne, Australia
†UROP, Bio21, Melbourne, Australia
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George Jerums;
George Jerums
*Department of Medicine, Austin Health and the University of Melbourne, Melbourne, Australia
‡Department of Endocrinology, Austin Health, Melbourne, Australia
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Que Lam;
Que Lam
§Department of Pathology, Austin Health, Melbourne, Australia
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Angela Chen;
Angela Chen
‡Department of Endocrinology, Austin Health, Melbourne, Australia
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Sara Baqar;
Sara Baqar
‡Department of Endocrinology, Austin Health, Melbourne, Australia
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Felicity Pyrlis;
Felicity Pyrlis
‡Department of Endocrinology, Austin Health, Melbourne, Australia
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Richard J. Macisaac;
Richard J. Macisaac
∥Department of Endocrinology, St. Vincent's Health and the University of Melbourne, Melbourne, Australia
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John Moran;
John Moran
¶Intensive Care Unit, Queen Elizabeth Hospital, Adelaide, Australia
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Elif I. Ekinci
*Department of Medicine, Austin Health and the University of Melbourne, Melbourne, Australia
‡Department of Endocrinology, Austin Health, Melbourne, Australia
**Menzies School of Health Research, Darwin, Australia
Correspondence: Dr Elif I. Ekinci (email [email protected]).
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Publisher: Portland Press Ltd
Received:
March 08 2013
Revision Received:
July 03 2013
Accepted:
July 23 2013
Accepted Manuscript online:
July 23 2013
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© The Authors Journal compilation © 2014 Biochemical Society
2014
Clin Sci (Lond) (2014) 126 (2): 147–154.
Article history
Received:
March 08 2013
Revision Received:
July 03 2013
Accepted:
July 23 2013
Accepted Manuscript online:
July 23 2013
Citation
Renata Libianto, George Jerums, Que Lam, Angela Chen, Sara Baqar, Felicity Pyrlis, Richard J. Macisaac, John Moran, Elif I. Ekinci; Relationship between urinary sodium excretion and serum aldosterone in patients with diabetes in the presence and absence of modifiers of the renin–angiotensin–aldosterone system. Clin Sci (Lond) 1 January 2014; 126 (2): 147–154. doi: https://doi.org/10.1042/CS20130128
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