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Urinary diluting capacity in elderly diabetic subjects.

F B Davis, A Van Son, P J Davis

    Experimental Gerontology
    |January 1, 1986
    PubMed
    Summary

    Elderly diabetic patients retain normal kidney diluting capacity, as measured by free water clearance (CH2O). Certain diabetes medications, like chlorpropamide, can impair this function, unlike tolazamide.

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    Area of Science:

    • Nephrology
    • Endocrinology
    • Gerontology

    Background:

    • Urinary concentrating ability declines with aging.
    • Urinary diluting capacity in aging populations, particularly those with diabetes, is less understood.
    • Type II diabetes can affect kidney function and fluid balance.

    Purpose of the Study:

    • To investigate the urinary diluting capacity in Type II diabetic patients across different age groups.
    • To assess the impact of specific sulfonylurea medications on free water clearance (CH2O) in elderly diabetics.
    • To determine if impaired diluting capacity contributes to hypoosmolar states in older diabetic individuals.

    Main Methods:

    • Water load testing was performed on Type II diabetic patients aged 47-70 years.
    • Free water clearance (CH2O) was measured to assess diluting capacity.
    • Glomerular filtration rate (GFR) and osmolar clearance (Cosm) were also evaluated.
    • The effects of tolazamide and chlorpropamide on CH2O were compared.

    Main Results:

    • Diabetic patients over 60 years old demonstrated preserved diluting capacity (Uosm < 100 mOsm/kg).
    • Tolazamide allowed for normal CH2O, while chlorpropamide reduced CH2O by 58% in subjects over 60.
    • GFR and CH2O were comparable between elderly (>60 years) and younger (≤60 years) diabetic subjects.
    • Osmolar clearance (Cosm) was only insignificantly lower in older diabetics.

    Conclusions:

    • Age-related decline in urinary diluting capacity is not a significant factor in elderly Type II diabetic patients.
    • Persistently normal GFR contributes to preserved diluting capacity in this population.
    • Chlorpropamide, but not tolazamide, impairs free water clearance in older diabetic patients, highlighting medication-specific effects.

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