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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

Category: CKD (Non-Dialysis)

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


  • Kobayashi, Hiroki, Nihon University School of Medicine, Tokyo, Japan
  • Abe, Masanori, Nihon University School of Medicine, Tokyo, Japan
  • Soma, Masayoshi, Nihon University School of Medicine, Tokyo, Japan
  • Takahashi, Katsutoshi, Showa General Hospital, Kodaira, Japan
  • Naruse, Mitsuhide, NHO Kyoto Medical Center, Kyoto, Japan

Group or Team Name

  • JPAS group

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.


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.


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.


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.


  • Government Support - Non-U.S.