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Kidney Week

Abstract: FR-PO208

High Renin-Aldosterone Ratio and Lateralization Index Are Associated with Adverse Renal Outcomes in Primary Aldosteronism Patients Who Underwent Adrenalectomy

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Kang, Sukyung, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  • Nam, Yooju, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  • Lee, Seon yeong, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  • Kim, Joohwan, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  • Nam, Ki Heon, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  • Han, Seung Hyeok, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  • Yoo, Tae-Hyun, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
Background

Previous studies reported that renal impairment develop in PA patients after adrenalectomy. However, aldosterone-induced glomerular hyperfiltration can lead to masked preoperative renal dysfunction in PA patients. We aimed to elucidate risk factors for renal impairment after adrenalectomy in these subjects.

Methods

In this retrospective study, total 109 PA patients and 193 pheochromocytoma patients as control, who underwent adrenalectomy between January 2006 and November 2017 at Yonsei University Severance Hospital, were enrolled. Acute kidney injury (AKI) after adrenalectomy was defined as increase in serum creatinine >0.3 mg/dL or decrease in eGFR >30% from preoperative baseline values. Postoperative chronic kidney disease (CKD) was defined as eGFR <60mL/min/1.73m2 for more than 3 months post-adrenalectomy. In all PA patients, adrenal vein sampling was performed to evaluate aldosterone and cortisol levels in each adrenal glands.

Results

Study patients, mean age was 49.6 years and 140(46.4%) were male. Among 109 PA patients, the incidence of AKI and CKD were 28 (25.7 %) and 34 (31.2 %). Meanwhile, among 193 pheochromocytoma patients, the incidence of AKI and CKD were 21(10.9%) and 6(3.1%). Multivariable regression analysis showed high relation of PA patients resulting in CKD compared to pheochromocytoma (Odds ratio 64.8). Univariable regression analysis identified coexisting diabetes mellitus (DM), duration of hypertension, high adrenal venous sampling (AVS) aldosterone-cortisol ratio and lateralization index as risk factors for development of postoperative CKD in PA patients. The AVS aldosterone-cortisol ratio in non-CKD and CKD patients were 84.93 and 113.86. Also lateralization index in non-CKD and CKD patients were 10.33 and 19.80.

Conclusion

Present study demonstrated incidence of CKD was more frequent in PA patients compared to pheochromocytoma patients post-adrenalectomy. Also, high AVS aldosterone-cortisol ratio and lateralization index are independent risk factors for adverse renal outcomes in PA patients post-adrenalectomy.