Abstract
Purpose
Glomerular filtration rate (GFR) has been reported to decrease after unilateral adrenalectomy in patients with primary aldosteronism (PA). The aim of this study was to identify clinical predictors for decreased GFR after adrenalectomy in patients with PA.
Methods
The records of 187 patients (98 patients with PA and 89 with non-PA adrenal disease) who were followed up for at least 6 months after unilateral adrenalectomy were retrospectively analyzed. Estimated GFR (eGFR) was investigated at 1, 3, and 6 months postoperatively. Preoperative risk factors for eGFR% decline at 1 month ([preoperative eGFR−eGFR at 1 month]/preoperative eGFR × 100) and postoperative CKD development were investigated.
Results
The eGFR decreased significantly at 1 month and remained stable in the PA group. However, there were no significant changes in eGFR in the non-PA group over the 6-month period. In the PA group, a high preoperative eGFR and high aldosterone to renin ratio (ARR) were independently associated with eGFR% decline at 1 month. In patients with PA but without preoperative CKD (n = 68), a low preoperative eGFR and high ARR were independent risk factors for developing postoperative CKD. The best preoperative cut-off values of eGFR and ARR for predicting the development of postoperative CKD were ≤ 102 ml/min/1.73 m2 and ≥ 448 ng/dl:ng/ml/h, respectively.
Conclusions
Renal function deteriorated significantly after unilateral adrenalectomy in patients with PA. Clinicians must pay attention to postoperative renal function in PA patients at elevated risk of developing decreased kidney function.
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References
Jin DC, Yun SR, Lee SW, Han SW, Kim W, Park J (2016) Current characteristics of dialysis therapy in Korea: 2015 registry data focusing on elderly patients. Kidney Res Clin Pract 35:204–211. https://doi.org/10.1016/j.krcp.2016.09.006
Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F, Investigators PS (2006) A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol 48:2293–2300. https://doi.org/10.1016/j.jacc.2006.07.059
Douma S, Petidis K, Doumas M, Papaefthimiou P, Triantafyllou A, Kartali N, Papadopoulos N, Vogiatzis K, Zamboulis C (2008) Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet 371:1921–1926. https://doi.org/10.1016/S0140-6736(08)60834-X
Fogari R, Preti P, Zoppi A, Rinaldi A, Fogari E, Mugellini A (2007) Prevalence of primary aldosteronism among unselected hypertensive patients: a prospective study based on the use of an aldosterone/renin ratio above 25 as a screening test. Hypertens Res 30:111–117. https://doi.org/10.1291/hypres.30.111
Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ (2005) Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 45:1243–1248. https://doi.org/10.1016/j.jacc.2005.01.015
Rossi GP, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mannelli M, Matterello MJ, Montemurro D, Palumbo G, Rizzoni D, Rossi E, Pessina AC, Mantero F, Participants PS (2006) Renal damage in primary aldosteronism: results of the PAPY Study. Hypertension 48:232–238. https://doi.org/10.1161/01.HYP.0000230444.01215.6a
Ribstein J, Du Cailar G, Fesler P, Mimran A (2005) Relative glomerular hyperfiltration in primary aldosteronism. J Am Soc Nephrol 16:1320–1325. https://doi.org/10.1681/ASN.2004100878
Sechi LA, Novello M, Lapenna R, Baroselli S, Nadalini E, Colussi GL, Catena C (2006) Long-term renal outcomes in patients with primary aldosteronism. JAMA 295:2638–2645. https://doi.org/10.1001/jama.295.22.2638
Utsumi T, Kawamura K, Imamoto T, Nagano H, Tanaka T, Kamiya N, Nihei N, Naya Y, Suzuki H, Ichikawa T (2013) Preoperative masked renal damage in Japanese patients with primary aldosteronism: identification of predictors for chronic kidney disease manifested after adrenalectomy. Int J Urol 20:685–691. https://doi.org/10.1111/iju.12029
Park SM, Jung WJ, Park JM, Rhee H, Kim IY, Seong EY, Lee DW, Lee SB, Kwak IS, Shin N, Song SH (2016) Unmasked chronic renal function deterioration after unilateral adrenalectomy in patients with primary aldosteronism. Kidney Res Clin Pract 35:255–258. https://doi.org/10.1016/j.krcp.2016.05.002
Wu VC, Yang SY, Lin JW, Cheng BW, Kuo CC, Tsai CT, Chu TS, Huang KH, Wang SM, Lin YH, Chiang CK, Chang HW, Lin CY, Lin LY, Chiu JS, Hu FC, Chueh SC, Ho YL, Liu KL, Lin SL, Yen RF, Wu KD, Group TS (2011) Kidney impairment in primary aldosteronism. Clin Chim Acta 412:1319–1325. https://doi.org/10.1016/j.cca.2011.02.018
Iwakura Y, Morimoto R, Kudo M, Ono Y, Takase K, Seiji K, Arai Y, Nakamura Y, Sasano H, Ito S, Satoh F (2014) Predictors of decreasing glomerular filtration rate and prevalence of chronic kidney disease after treatment of primary aldosteronism: renal outcome of 213 cases. J Clin Endocrinol Metab 99:1593–1598. https://doi.org/10.1210/jc.2013-2180
Tanase-Nakao K, Naruse M, Nanba K, Tsuiki M, Tagami T, Usui T, Okuno H, Shimatsu A, Hashimoto S, Katabami T, Ogo A, Okumura A, Umakoshi H, Suzuki T (2014) Chronic kidney disease score for predicting postoperative masked renal insufficiency in patients with primary aldosteronism. Clin Endocrinol 81:665–670. https://doi.org/10.1111/cen.12497
Kim do H, Kwon HJ, Ji SA, Jang HR, Jung SH, Kim JH, Kim JH, Lee JE, Huh W, Kim YG, Kim DJ, Oh HY (2016) Risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism. Medicine 95:e3930. https://doi.org/10.1097/MD.0000000000003930
Ferrari P, Shaw SG, Nicod J, Saner E, Nussberger J (2004) Active renin versus plasma renin activity to define aldosterone-to-renin ratio for primary aldosteronism. J Hypertens 22:377–381
Kem DC, Weinberger MH, Mayes DM, Nugent CA (1971) Saline suppression of plasma aldosterone in hypertension. Arch Intern Med 128:380–386
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, Ckd EPI (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612
Sechi LA, Di Fabio A, Bazzocchi M, Uzzau A, Catena C (2009) Intrarenal hemodynamics in primary aldosteronism before and after treatment. J Clin Endocrinol Metab 94:1191–1197. https://doi.org/10.1210/jc.2008-2245
Kuo CC, Wu VC, Tsai CW, Wu KD, Taiwan Primary Aldosteronism Investigation Study G (2011) Relative kidney hyperfiltration in primary aldosteronism: a meta-analysis. J Renin Angiotensin Aldosterone Syst 12:113–122. https://doi.org/10.1177/1470320310391331
Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, Sechi LA (2007) Relationships of plasma renin levels with renal function in patients with primary aldosteronism. Clin J Am Soc Nephrol 2:722–731. https://doi.org/10.2215/CJN.00050107
Hollenberg NK (2004) Aldosterone in the development and progression of renal injury. Kidney Int 66:1–9. https://doi.org/10.1111/j.1523-1755.2004.00701.x
Danforth DN Jr, Orlando MM, Bartter FC, Javadpour N (1977) Renal changes in primary aldosteronism. J Urol 117:140–144
Catena C, Colussi GL, Marzano L, Sechi LA (2012) Predictive factors of left ventricular mass changes after treatment of primary aldosteronism. Horm Metab Res 44:188–193. https://doi.org/10.1055/s-0032-1301902
Favia G, Lumachi F, Scarpa V, D’Amico DF (1992) Adrenalectomy in primary aldosteronism: a long-term follow-up study in 52 patients. World J Surg 16:680–683. (discussion 683–684)
Catena C, Colussi G, Sechi LA (2015) Treatment of primary aldosteronism and organ protection. Int J Endocrinol 2015:597247. https://doi.org/10.1155/2015/597247
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Sang Heon Song and Hyun Chul Chung are equally contributed to this article.
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Kim, I.Y., Park, I.S., Kim, M.J. et al. Change in kidney function after unilateral adrenalectomy in patients with primary aldosteronism: identification of risk factors for decreased kidney function. Int Urol Nephrol 50, 1887–1895 (2018). https://doi.org/10.1007/s11255-018-1887-9
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DOI: https://doi.org/10.1007/s11255-018-1887-9