Association Between Acute Fall in Estimated Glomerular Filtration Rate After Treatment for Primary Aldosteronism and Long-Term Decline in Renal Function.

Abstract

Primary aldosteronism causes renal structural damage after glomerular hyperfiltration, and primary aldosteronism-specific treatment leads to an acute fall in estimated glomerular filtration rate (eGFR). We investigated whether this change affected the long-term eGFR slope in a retrospective cohort from the multicenter Japan Primary Aldosteronism Study. We allocated patients with primary aldosteronism to the adrenalectomy (n=202) and MR (mineralocorticoid receptor) antagonist (n=303) groups based on their treatment history and analyzed the association between the initial eGFR fall and long-term eGFR slope. The increased age, low serum potassium levels, high eGFR, and high plasma aldosterone levels were independent predictors for a large initial eGFR fall in both groups. Our analysis of tertiles based on the initial eGFR fall revealed that in the MR antagonist group, patients with a small initial eGFR fall had a significantly steeper long-term eGFR slope than those with a large initial fall (tertile 1 versus 2, P=0.025; tertile 1 versus 3, P=0.017). These associations were not identified in the adrenalectomy group. Thus, the smaller the acute fall in eGFR by initiation of MR antagonists, the greater was the rate of long-term eGFR decline. While the acute fall in eGFR induced by primary aldosteronism-specific treatment is occasionally a clinical concern, our findings highlight the favorable implications of the acute fall with respect to long-term renal outcomes.

• Authors: Hiroki Kobayashi, Masanori Abe, Yoshihiro Nakamura, Katsutoshi Takahashi, Megumi Fujita, Yoshiyu Takeda, Takashi Yoneda, Isao Kurihara, Hiroshi Itoh, Mika Tsuiki, Norio Wada, Takamasa Ichijo, Takuyuki Katabami, Yoshihiro Ogawa, Junji Kawashima, Takanobu Yoshimoto, Masakatsu Sone, Nobuya Inagaki, Minemori Watanabe, Kohei Kamemura, Yuichi Matsuda, Shoichiro Izawa, Makito Tanabe, Akiyo Tanabe, Tomoko Suzuki, Mitsuhide Naruse, JPAS/JRAS Study Group
• Journal: Hypertension (Dallas, Tex. : 1979) (Hypertension) Vol. 74 Issue 3 Pg. 630-638 (09 2019) ISSN: 1524-4563 [Electronic] United States
• PMID: 31327258 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Mineralocorticoid Receptor Antagonists

Topics

• Adrenalectomy (methods)
• Cohort Studies
• Disease Progression
• Female
• Glomerular Filtration Rate
• Humans
• Hyperaldosteronism (diagnosis, drug therapy, surgery)
• Japan
• Kidney Function Tests
• Male
• Middle Aged
• Mineralocorticoid Receptor Antagonists (therapeutic use)
• Multivariate Analysis
• Prognosis
• Regression Analysis
• Renal Insufficiency, Chronic (epidemiology, etiology)
• Retrospective Studies
• Treatment Outcome