Vasopressin in healthy subjects: influencing the balance?

Objective: Vasopressin, also known as anti-diuretic hormone (ADH) plays an important role in maintaining homeostasis. Besides its beneficial effects, recent studies suggested that vasopressin may play a detrimental role in renal disease progression. It therefore becomes of interest to find factors that influence vasopressin concentration, especially modifiable ones, because intervention on these factors may prevent the detrimental effects associated with this hormone. Study question: What are modifiable factors that are associated with vasopressin concentration in healthy subjects? Methods: This study was performed using data of a large general population cohort study (n=8,592), the Prevention of Renal and Vascular ENd-stage Disease (PREVEND) Study, that is performed in Groningen, the Netherlands. Copeptin concentration was measured in serum as surrogate for vasopressin concentration. In addition, extensive information on subject related data were obtained during a visit to an outpatient department. The associations of patient related factors with vasopressin concentration was assessed using multivariable regression analysis. The final model was obtained using stepwise backward regression analysis, adopting a p-value <0.05 to maintain factors in the model. Significant variables were thereafter one by one depicted in a figure that was adjusted for all other significant variables. Results: We corroborate that fluid intake (p<0.001) and gender (p<0.001) are significantly associated with copeptin concentration, with high fluid intake and female gender being associated with lower copeptin values. In addition we found that when adjusted for fluid intake, gender and age, several other subject related factors were associated with copeptin concentration. The final stepwise backward model revealed associations with higher vasopressin concentration for, in order of the strength of their association, lower kidney function (eGFR, p<0.001), higher sodium intake (p<0.001), current smoking (p<0.001), use of alcohol (p<0.001), higher blood pressure (SBP, p<0.001), use of glucose lowering medication (p 0.02), use of coffee (p 0.03), obesity (BMI, p<0.001) and higher serum glucose (p