Kidney impairment in primary aldosteronism
Journal
Clinica Chimica Acta
Journal Volume
412
Journal Issue
15-16
Pages
1319-1325
Date Issued
2011
Author(s)
Bor-Wen Cheng
Chin-Chi Kuo
Hung-Wei Chang
Chien-Yu Lin
Jainn-Shiun Chiu
Fu-Chang Hu
Abstract
Background: Kidney impairment is noted in primary aldosteronism (PA), and probably initiated by glomerular hyperfiltration. Methods: A prospectively defined survey was conducted on 602 patients who were suspected of PA in the multiple-center Taiwan Primary Aldosteronism Investigation (TAIPAI) database. Estimated glomerular filtration rate (eGFR) was calculated and followed up at 1. yr after treatment. Results: The diagnosis of PA was confirmed in 330 patients. Among them 17% of these patients had kidney impairment (eGFR<60ml/min/1.73m2). Patients with PA had a higher prevalence of estimated hyperfiltration than those with essential hypertension (EH) (14.5% vs. 7.0%, p=0.005). The eGFR independently predicted PA (OR, 1.017) in the propensity-adjusted multivariate logistic model. In PA, plasma renin activity and lower serum potassium (p=0.018) was correlated with kidney impairment (p=0.001), while this relationship was not significant in patients with EH. Either unilateral adrenalectomy or treatment of spironolactone for PA patients caused a decrease of eGFR (p<0.001). Pre-operative hypokalemia (p=0.013) and the long latency of hypertension (p=0.016) could enhance the significant decrease of eGFR after adrenalectomy. Conclusions: Patients with aldosteronism had relative estimated hyperfiltration than patients with EH. Calculation of eGFR may increase the specificity in identifying patients with PA. Our findings demonstrate the correlation of serum potassium and renin with estimated hyperfiltration in PA and their relationship to kidney damage. These results provide a high priority for future renal protective strategies and methods for the early diagnosis and prompt treatment of PA. ? 2011.
SDGs
Type
journal article