Predictors of decreasing glomerular filtration rate and prevalence of chronic kidney disease after treatment of primary aldosteronism: Renal outcome of 213 cases

Yoshitsugu Iwakura, Ryo Morimoto, Masataka Kudo, Yoshikiyo Ono, Kei Takase, Kazumasa Seiji, Yoichi Arai, Yasuhiro Nakamura, Hironobu Sasano, Sadayoshi Ito, Fumitoshi Satoh

研究成果: Article査読

61 被引用数 (Scopus)

抄録

Context: In primary aldosteronism (PA), glomerular hyperfiltration due to excessive aldosterone is considered to underestimate actual renal damage. Objective: Our objectives were to determine the prevalence of chronic kidney disease (CKD) in PA and identify the predictors of decreasing estimated glomerular filtration rate (eGFR) after treatment. Design and Setting: This was a 12-month prospective study of patients with PA treated at Tohoku University Hospital. Patients and Interventions: All patients were treated according to the results of adrenal venous sampling; 102 patients with aldosterone-producing adenoma underwent adrenalectomy, and 111 with bilateral hyperaldosteronism were treated with mineralocorticoid receptor antagonists. Main Outcome Measures: Electrolytes, blood pressure, and indicators of renal function were determined at 1 and 12 months after intervention. Results: Blood pressure, urinary albumin excretion (UAE), and eGFR, which significantly decreased at 1 month after treatment of PA, did not further decrease at 12 months. Prevalence of CKD, which was 15.7% in aldosterone-producing adenoma and 8.1% in bilateral hyperaldosteronism at the first visit, increased to 37.1% and 28.3%, respectively, at the end of study (P.0001). Multivariate regression analysis revealed that higher UAE and lower serum potassium levels were found to be independent predictors of decreasing eGFR after intervention. Conclusions: This large cohort study shows that the prevalence of CKD in PA was increased after treatment and that higher UAE and lower serum potassium levels at the first visit were predictors of decreasing eGFR after treatment of PA. To prevent a large decrease of eGFR after intervention, PA patients should be diagnosed before evolution to severe albuminuria and hypokalemia.

本文言語English
ページ(範囲)1593-1598
ページ数6
ジャーナルJournal of Clinical Endocrinology and Metabolism
99
5
DOI
出版ステータスPublished - 2014 5

ASJC Scopus subject areas

  • 内分泌学、糖尿病および代謝内科学
  • 生化学
  • 内分泌学
  • 臨床生化学
  • 生化学、医学

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