Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
October 8, 2026 · via Europe PMC
Copeptin and urine concentrating capacity predict kidney function decline in lithium-treated patients.
Zittema D, van der Aa M, Doornebal J, Bisseling EM, Klumpers UMH, Kupka RW, Nijenhuis T, Kerckhoffs APM.
AI summary — for doctors, generated from the abstract only
Copeptin and urine concentrating ability were associated with later kidney function decline in lithium-treated patients.
What was studied
Cohort of 98 lithium-treated patients given a desmopressin test of maximal urine concentrating capacity, with blood and urine biomarkers measured and kidney function follow-up in 93.
Key findings
- 51% had mildly impaired concentrating capacity (600-800 mOsm/kg) and 16% moderately decreased (300-600)
- 1 patient (1%) had severely impaired capacity
- Multiple biomarkers tracked concentrating capacity; copeptin and concentrating capacity were associated with future kidney function decline
Clinical relevance
Psychiatrists and nephrologists following lithium patients may find a marker to flag those at risk for kidney decline.
Who should care
Limitations
Observational study of modest size, and the abstract does not give effect sizes for the decline associations.
Copeptin could be a candidate marker, pending validation.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Introduction and objectives
A common early side effect of lithium treatment in bipolar disorder is a reduced urine concentrating capacity possibly progressing to arginine vasopressin (AVP) resistance (AVP-R), also known as lithium-induced nephrogenic diabetes insipidus (Li-NDI). Long term lithium therapy can also lead to chronic kidney disease (CKD) with kidney function decline. Due to lack of markers to identify Li-NDI, it is often overseen even though prevalence and impact on quality of life are substantial. Moreover, the correlation between reduction of urine concentrating capacity and CKD remains unclear. This study aims to identify markers for Li-NDI and future kidney function decline.
Methods
98 patients treated with lithium underwent a desmopressin (DDAVP) test to determine maximal urine concentrating capacity (MUCC) after inclusion in 2012/2013. Plasma copeptin, urine biomarkers AQP-2, NAG, KIM-1, HFABP, NGAL and urine-to-plasma urea ratio (UPU) were measured. Long term follow-up data of kidney function decline during lithium therapy was collected of 93 out of 98 patients.
Results
Fifty patients (51%) had an mildly impaired MUCC (urine osmolality 600-800 mOsmol/kg), 16 patients (16%) a moderately decreased MUCC (300-600 mOsm/kg) and 1 patient (1%) a severely impaired MUCC (<300 mOsm/kg). Baseline eGFR, UPU, copeptin, KIM-1, HFABP and NGAL were significantly associated with MUCC when corrected for age, sex and eGFR (when appropriate) (eGFR: St. β=0.44, P ≤ 0.001, UPU: St. β=0.34, P ≤ 0.001; copeptin: St. β=-0.23, P = 0.02; KIM-1: St. β=-0.23, P = 0.02, HFABP: St. β=-0.21, P = 0.03) NGAL: St. β=-0.25, P = 0.02). eGFR, MUCC and copeptin at baseline were associated with kidney function during follow-up using mixed linear model analysis (eGFR: β=0.97 95%CI [0.88;1.06], P < 0.001; MUCC: β=0.05 95%CI[0.03;0.06], P < 0.001 and copeptin:-β=7.10 95%CI[-10.9;-3.28], P < 0.001).
Conclusion
Multiple biomarkers were identified to test for MUCC. Copeptin is particularly interesting as it was, together with MUCC, associated with future kidney function decline.
DOI
10.1093/ndt/gfag219
PMID
42847926
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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