Volume expansion by water immersion resulted in an impaired natriuretic response in diabetic subjects compared to normal controls (21 mmol vs 39 mmol, P<0.01), regardless of autonomic neuropathy.
Observational (n=28)
Does volume expansion via water immersion alter hormonal and renal natriuretic responses in insulin-dependent diabetic subjects compared to normal controls?
Diabetic patients retain sodium more avidly than healthy controls during volume expansion, a phenomenon not explained by differences in circulating natriuretic hormones or the presence of autonomic neuropathy.
Absolute Event Rate: 21% vs 39%
p-value: p=<0.01
The hormonal and renal response to volume expansion, produced by water immersion for 4 h, was studied in 14 insulin-dependent diabetic subjects (seven without complications, seven with autonomic neuropathy) and in 14 age-and-sex-matched normal control subjects. The diabetic subjects showed an impaired natriuretic response to volume expansion (total amount of sodium excreted 21 mmol compared to 39 mmol in normals, P less than 0.01) but the response did not differ in those with and without autonomic neuropathy. There was no significant difference in the suppression of plasma renin or aldosterone during immersion in either group. Plasma catecholamines suppressed on immersion in all groups. Basal values were lowest in the group with autonomic involvement. Atrial natriuretic peptide levels showed a twofold rise (from 4.8 to 9.6 pmol/l, P less than 0.01) on immersion. There was no significant difference in the levels of this hormone between diabetic patients and normal subjects or between those diabetics with and those without autonomic neuropathy. The present study confirms that diabetic subjects retain sodium avidly during volume expansion. This enhancement cannot be ascribed to any measurable difference in the levels of circulating hormones known to be involved in natriuresis and is not influenced by the presence of autonomic neuropathy.
OʼHARE et al. (Mon,) conducted a observational in Insulin-dependent diabetes with and without autonomic neuropathy (n=28). Volume expansion by water immersion vs. Normal control subjects was evaluated on Total amount of sodium excreted (p=<0.01). Volume expansion by water immersion resulted in an impaired natriuretic response in diabetic subjects compared to normal controls (21 mmol vs 39 mmol, P<0.01), regardless of autonomic neuropathy.
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