Primary Aldosteronism in CKD
October 22, 2020 | 10:00 AM - 12:00 PM
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Primary Aldosteronism in CKD
- CVD, BP, and Kidney Diseases: Exploring the Link
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
- Wachtel, Heather, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Ermer, Jae, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Davio, Angela C., University of Michigan, Ann Arbor, Michigan, United States
- Tezuka, Yuta, University of Michigan, Ann Arbor, Michigan, United States
- Hundemer, Gregory L., Ottawa Hospital, Ottawa, Ontario, Canada
- Turcu, Adina, University of Michigan, Ann Arbor, Michigan, United States
- Vaidya, Anand, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
- Cohen, Debbie L., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
Angela C. Davio,
Gregory L. Hundemer,
Debbie L. Cohen,
Primary aldosteronism (PA) is a common cause of secondary hypertension. Unilateral causes of PA are potentially cured with adrenalectomy. Treatment of PA in CKD is often avoided for concerns of safety and efficacy.
We conducted a retrospective cohort study of patients with PA and CKD (eGFR <60 ml/min/1.73m2) at 3 institutions (2009-2019). eGFR was calculated using CKD-EPI. Statistical comparison utilized the student’s t-test, Chi-square test, and Wilcoxon rank-sum test.
Of 250 patients included, mean age was 56.6years (±10.5), and 64% were female. Median plasma aldosterone concentration was 29.0 ng/dl (IQR:20.3-47.4); median plasma renin activity was 0.2 ng/ml/hr (IQR:0.1-0.6) and aldosterone-renin ratio was 119 (ng/dl)/(ng/ml/hr) (IQR:63.5-240.0). Median eGFR on initial evaluation was 49.0 ml/min/1.73m2 (IQR:40.3-58.2). Adrenal vein sampling (AVS) was performed in all patients; unilateral PA was diagnosed in 67.6% (n=169). Adrenalectomy was performed in 163 subjects. Surgical pathology demonstrated adrenocortical adenomas in 66.9%, nodular hyperplasia in 4.9%, and nodular hyperplasia with a dominant nodule in 10.4%. The median tumor size was 1.2 cm (IQR:1.0-1.8). No differences were detected in baseline MAP, number of anti-hypertensive medications (AHM), serum creatinine, or potassium levels between adrenalectomy patients and those medically managed. Adrenalectomy patients had significantly lower AHM requirements at 1 month (2.0 vs. 4.5, p<0.001), 6 months (2.0 vs. 3.0, p=0.002) and 12 months after surgery (2.0 vs. 4.0, p<0.001) compared with medically managed patients. Adrenalectomy patients demonstrated stable eGFR from baseline to 12 months postoperatively, while medically managed patients had a statistically significant decrease in eGFR from baseline to 12 months (p=0.040). There was no difference between groups in cardiovascular outcomes.
Patients with CKD and unilateral PA experience significant and durable decrease in AHM requirement and demonstrate stabilization of eGFR after adrenalectomy when compared to medically managed patients. AVS was successful despite reduced GFR. This study demonstrates that patients with CKD and suspected PA should undergo evaluation to determine whether they have surgically curable disease, as there is a clear benefit in medication reduction and stabilization of eGFR at 12 months.