Lack of Effect of Captopril on Glomerular Hyperfiltration in Normoalbuminuric Normotensive Insulin-Dependent Diabetic Patients

Abstract

The aim of the present study was to evaluate the effects of captopril on the glomerular filtration rate (GFR) and urinary albumin excretion rate (UAER) of normoalbuminuric normotensive insulin-dependent diabetes mellitus (IDDM) patients with and without glomerular hyperfiltration. Eleven normoalbuminuric (UAER < 30 µg/min) patients (age: 34.3 ± 4.6 years; diabetes duration: 9.5 ± 6.4 years) participated in the study. Six patients were considered to be hyperfiltering (GFR ≥ 134 ml/min/ 1.73 m²). GFR (⁵¹Cr-EDTA single injection technique), extracellular volume (ECV; distribution volume of ⁵¹Cr-EDTA), UAER (RIA) and metabolic and biochemical parameters were measured at baseline, after 6 weeks on captopril (25 mg p.o. twice daily) and after 6 weeks off captopril. Plasma renin activity (PRA; RIA), plasma aldosterone (RIA) and blood volume (⁵¹Cr red cell labeled) were measured at baseline and after 6 weeks on captopril. The baseline clinical and laboratory characteristics of hyperfiltering and normofiltering IDDM patients were similar. GFR did not change during the study (144.1 ± 28.8; 139.7 ± 21.8; 132.8 ± 29.9 ml/min/1.73 m²) either in patients with hyperfiltration (164.6 ± 20.7; 153.8 ± 18.3; 148.6 ± 31.0 ml/min/1.73 m²; n = 6) or without hyperfiltration (119.6 ± 11.1; 123.2 ± 11.9; 113.8 ± 14.4 ml/min/1.73 m²; n = 5). Also, ECV (22.2 ± 3.6; 21.5 ± 4.3; 21.5 ± 3.5 L/1.73 m²), UAER (3.9 [0.4-22.1]; 4.0 [0.2-11.4]; 3.7 [2.0-26.2] µg/min), systolic (112 ± 13; 105 ± 10; 111 ± 11 mmHg) and diastolic (76 ± 12; 72 ± 9; 73 ± 12 mmHg) blood pressure did not change. No difference in blood volume (60.8 ± 10.4; 62.3 ± 8.4 ml/kg) or plasma aldosterone (10.4 ± 4.9; 7.7 ± 3.8 ng/dl) was observed between baseline values and values after captopril use. PRA increased (2.4 [0.4-22.1]; 12.9 [2.2-41.1] ng/ml/h) at the end of 6 weeks on captopril (P = 0.002). Fasting plasma glucose, glycated hemoglobin, fructosamine, plasma cholesterol and potassium, 24 h urinary urea and sodium were similar during the study. These results were unchanged when patients with and without hyperfiltration were analyzed as separate groups. From baseline to the end of 6 weeks on captopril there was no correlation between change in GFR and change in glycated hemoglobin (r = 0.02, P = 0.96), systolic (r = 0.23; P = 0.49) and diastolic (r = - 0.32, P = 0.32) blood pressure, urinary urea (r = 0.21; P = 0.53) and UAER (r = - 0.16; P = 1.00). In conclusion, captopril has no effect on the GFR and UAER of normoalbuminuric normotensive IDDM patients irrespective of the presence of glomerular hyperfiltration.

Key words

Type I Diabetes Mellitus - Angiotensin Converting Enzyme Inhibitors - Glomerular Filtration Rate