Subclinical Primary Aldosteronism in Diabetes At-Risk for Kidney Disease
Brigham and Women's Hospital
Summary
The aim of this protocol is to assess the presence and severity of primary aldosteronism pathophysiology in patients with type 2 diabetes who have, or are at-risk for developing, chronic kidney disease.
Description
Diabetes is the leading cause of chronic kidney disease (CKD). When combined, diabetes with CKD exponentially increases risk for cardiovascular disease (CVD) and death. Preventing or delaying CKD in diabetes would substantially decrease these adverse outcomes, save billions in healthcare expenditures, and improve quality of life for those at high-risk for dialysis-dependent kidney failure. Emerging evidence strongly suggests that primary aldosteronism (PA) pathophysiology is a causative mechanism for the development and progression of CKD in diabetes. PA pathophysiology is characterized by re…
Eligibility
- Age range
- 18–80 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. Age 18-80 years 2. Known diagnosis of type 2 diabetes; or unknown/unclear diagnosis of type 2 diabetes but hemoglobin A1c 5.7-6.4% on screening while on treatment with metformin or SGLT2 inhibitor or GLP1RA class of medications; or unknown/unclear diagnosis of type 2 diabetes but hemoglobin A1c 6.5-8.9% on screening. 3. One of the two following inclusion criteria i. At-risk for developing CKD: eGFR 60-89 mL/min/1.73m2 plus at least one of the following: * Moderate albuminuria (30-300 mg/g) * Diagnosis of hypertension or active treatment with anti-hypertensive med…
Interventions
- Diagnostic TestOral sodium suppression test
Oral sodium suppression test (\~2 grams of supplemental sodium for 3 days)
- Diagnostic TestSaline suppression test
Saline suppression test (2 liters of saline)
- Diagnostic TestCaptopril suppression test
Captopril suppression test (50mg of captopril)
- Diagnostic TestDexamethasone suppression test
1mg of dexamethasone
- Diagnostic TestCosyntropin stimulation test
250mcg of cosyntropin
Location
- Brigham and Women's HospitalBoston, Massachusetts