The Role of Aldosterone in the Development of Chronic Kidney Disease in Individuals with Type 2 Diabetes

Abstract

Abstract: modern statistics confirm that diabetes has become an epidemic of the 21st century. According to the forecasts of the International Diabetes Federation, by 2045, the number of people with diabetes is expected to reach 784 million. Approximately 90% of cases involve type 2 diabetes, which is a major contributor to the development of chronic kidney and cardiovascular diseases. The role of aldosterone in the progression of persistent kidney filtration rate disorders is particularly important due to the high prevalence of microvascular complications in individuals with type 2 diabetes, especially diabetic nephropathy. The activation of the renin-angiotensin-aldosterone system, alongside inflammatory processes, fibrotic changes in the kidneys, endothelial dysfunction, and disturbances in carbohydrate metabolism, are key pathogenetic factors in the development and progression of cardiorenal-metabolic syndrome. This syndrome, officially recognized by the American Heart Association, encompasses chronic kidney disease, which significantly worsens the clinical condition and prognosis of individuals with type 2 diabetes. Understanding the relationship between aldosterone levels and irreversible changes in kidney filtration rate in patients with type 2 diabetes is essential for exploring the mechanisms of the renin-angiotensin-aldosterone system’s impact on kidney function in diabetic nephropathy. This study analyzed a range of parameters, including age, anthropometric indicators, carbohydrate metabolism, physical data, aldosterone levels, vitamin D (25OH) levels, and the albumin-to-creatinine ratio in daily urine. Participants were grouped according to their glomerular filtration rate, with a rate of <60 ml/min/1.73 m² indicating persistent pathological changes in the kidneys among individuals with type 2 diabetes. The results revealed a negative correlation between aldosterone levels and glomerular filtration rate in individuals with persistent kidney changes caused by diabetic nephropathy. These changes serve as risk factors for cardiovascular diseases. Elevated aldosterone levels, albuminuria, decreased glomerular filtration rate, and reduced vitamin D (25OH) levels were identified as early indicators of chronic kidney disease in individuals with type 2 diabetes.