Published online Mar 6, 2018. doi: 10.5527/wjn.v7.i2.51
Peer-review started: December 18, 2017
First decision: January 23, 2018
Revised: January 29, 2018
Accepted: February 28, 2018
Article in press: February 28, 2018
Published online: March 6, 2018
The availability of disease-modifying drugs for the management of autosomal dominant polycystic kidney disease (ADPKD) has accelerated the need to accurately predict renal prognosis and/or treatment response in this condition. Arginine vasopressin (AVP) is a critical determinant of postnatal kidney cyst growth in ADPKD. Copeptin (the C-terminal glycoprotein of the precursor AVP peptide) is an accurate surrogate marker of AVP release that is stable and easily measured by immunoassay. Cohort studies show that serum copeptin is correlated with disease severity in ADPKD, and predicts future renal events [decline in renal function and increase in total kidney volume (TKV)]. However, serum copeptin is strongly correlated with creatinine, and its additional value as a prognostic biomarker over estimated glomerular filtration rate and TKV is not certain. It has also been suggested that copeptin could be a predictive biomarker to select ADPKD patients who are most likely to benefit from AVP-modifying therapies, but prospective data to validate this assumption are required. In this regard, long-term randomised clinical trials evaluating the effect of prescribed water intake on renal cyst growth may contribute to addressing this hypothesis. In conclusion, although serum copeptin is aligned with the basic pathogenesis of ADPKD, further rigorous studies are needed to define if it will contribute to enabling the delivery of personalised care in ADPKD.
Core tip: Serum copeptin is correlated with disease severity in autosomal dominant polycystic kidney disease (ADPKD), and predicts future renal events (decline in renal function and increase in total kidney volume). The aim of this review is to critically evaluate the role of copeptin as a prognostic biomarker of renal outcomes in ADPKD, and if it has potential as a predictive marker of treatment response.