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Comparisons of risk factors for post-treatment renal dysfunction between the two major subtypes of primary aldosteronism

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Abstract

Objective

Aldosterone-producing adenoma (APA) and bilateral idiopathic hyperaldosteronism (IHA) are the most common subtypes of primary aldosteronism (PA), and the PA subtype dictates the treatment options. This study aimed to identify predictors of declined estimated glomerular filtration rate (eGFR) following each treatment in patients with APA and IHA.

Methods

We retrospectively investigated 45 patients with APA who had undergone adrenalectomy (ADX) and 37 patients with IHA who had received treatment with a mineralocorticoid receptor antagonist (MRA) to identify pre-treatment risk factors for eGFR decline during the post-treatment follow-up period.

Results

Patients with APA who underwent ADX exhibited higher eGFR declines than patients with IHA treated with MRA at the 6-month post-treatment evaluation point. A high preoperative plasma aldosterone concentration (PAC) in patients with APA and a high body mass index (BMI) in patients with IHA were identified as independent predictors of higher eGFR decline at 6 months post-treatment (β=0.42 and β=0.36, respectively). In patients with APA, the cutoff PAC to best predict a 20% decrease in eGFR following ADX, as determined by receiver operating characteristic analysis, was 524 pg/mL. In patients with IHA, the cutoff BMI to best predict a 10% decrease in eGFR following MRA administration was 25.3 kg/m2. In addition, lower preoperative flow-mediated vasodilation was associated with eGFR decline after ADX in patients with APA.

Conclusions

Greater attention should be given to the above-mentioned risk factors to prevent renal impairment following each treatment in patients with both APA and IHA.

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Acknowledgements

We are grateful to the staff of the Department of Internal Medicine at Tokyo Women’s Medical University for their assistance.

Funding

This study was supported, in part, by a Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (JSPS KAKENHI; Grant Number 22K08167, to S.M.).

Author contributions

D.W., S.M., N.M. and A.I. contributed to the design and implementation of the research, to the analysis of the results and to the writing of the manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Daisuke Watanabe, Satoshi Morimoto, Noriko Morishima & Atsuhiro Ichihara

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  1. Daisuke Watanabe
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  2. Satoshi Morimoto
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  3. Noriko Morishima
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  4. Atsuhiro Ichihara
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Correspondence to Satoshi Morimoto.

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Watanabe, D., Morimoto, S., Morishima, N. et al. Comparisons of risk factors for post-treatment renal dysfunction between the two major subtypes of primary aldosteronism. Endocrine 84, 245–252 (2024). https://doi.org/10.1007/s12020-023-03627-w

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  • DOI: https://doi.org/10.1007/s12020-023-03627-w

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