Kidney Week

Abstract: FR-PO207

Effect of Aldosterone-Renin Level on Glomerular Filtration Rate Slope in Patients with Primary Aldosteronism: A Retrospective, Multi-Center Cohort Study

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - II
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Kobayashi, Hiroki, Nihon University School of Medicine, Tokyo, Japan

Hiroki Kobayashi,

• Abe, Masanori, Nihon University School of Medicine, Tokyo, Japan

Masanori Abe,

• Soma, Masayoshi, Nihon University School of Medicine, Tokyo, Japan

Masayoshi Soma,

• Takahashi, Katsutoshi, Showa General Hospital, Kodaira, Japan

Katsutoshi Takahashi,

• Naruse, Mitsuhide, NHO Kyoto Medical Center, Kyoto, Japan

Mitsuhide Naruse,

Group or Team Name

• JPAS group

Background

Primary aldosteronism (PA) is recognized as renin-independent aldosterone overproduction, leading to glomerular hyperfiltration. Recent studies demonstrated higher morbidity of renal damage in PA patients compared with essential hypertension. In this study, we aimed to investigate the association of renin-aldosterone levels with adrenalectomy-induced estimated glomerular filtration rate (eGFR) decrease. Furthermore, we also sought to investigate whether renin-aldosterone level affect eGFR slope in PA patients who did or didn’t undergo adrenalectomy.

Methods

This is a multicenter retrospective cohort from the Japan Primary Aldosteronism Study. In a total of 2,814 patients with PA, we identified three groups, A) 487 patients who underwent adrenalectomy, B) 284 patients who did not undergo adrenalectomy with follow-up data, and C) 106 patients who underwent adrenalectomy with follow-up data.
In group A, we evaluated the predictors of adrenalectomy-induced eGFR decrease for aldosterone producing adenoma by linear regression model. In groups B and C, we analyzed associations between renin-aldosterone levels and annual eGFR decline (mL/min/1.73 m²/year) by partial spearman correlation analysis, and the association was also assessed using ordinal logistic regression models adjusted for clinical cofounders.

Results

In group A, suppressed plasma renin activity (PRA) was an independent predictor for adrenalectomy-induced eGFR decrease. In group B, suppressed PRA was significantly correlated with higher annual eGFR decline (r = -0.13, P = 0.036). Furthermore, quartiled PRA was also associated with annual eGFR decline in ordinal logiostic regression model (adjusted cumulative odds ratio = -0.087, P = 0.019), although these associations could not be identified in group C.

Conclusion

Our study demonstrated that excess aldosterone levels with renin suppression affects eGFR slope, and glomerular hyperfiltration is one of the explanation of this association. Furthermore, suppressed PRA which indicate the inadequate mineralocorticoid receptor blockade might be a marker for steeper eGFR slope in patients with PA.

Funding

• Government Support - Non-U.S.