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Abstract: PO1036

Paradoxical Effect of Aldosterone on Cardiovascular Outcome in Maintenance Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Yun, Kyu Sang, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea (the Republic of)
  • Choi, Sun Ryoung, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi, Korea (the Republic of)
  • Park, Hayne C., Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea (the Republic of)
  • Kim, Do Hyoung, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea (the Republic of)
  • Cho, Ajin, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea (the Republic of)
  • Kim, Juhee, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea (the Republic of)
  • Noh, Jung Woo, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea (the Republic of)
  • Lee, Youngki, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea (the Republic of)
Background

Patients with end-stage kidney disease have an increased risk of cardiovascular (CV) events and left ventricular diastolic dysfunction (LVDD) is known to contribute to high occurrence of CV mortality. Although high serum aldosterone level is involved in the development of CV complications in general population, this association is unclear in patients undergoing hemodialysis (HD). We aimed to determine the impact of serum aldosterone on LVDD and CV mortality among HD patients.

Methods

We performed a prospective cohort study of maintenance HD patients without CV disease. Patients were divided into two groups according to the median level of serum aldosterone. All patients underwent echocardiography to evaluate diastolic dysfunction. Proportions of LVDD and CV mortality were compared between high and low aldosterone groups.

Results

We enrolled a total of 60 adult patients (mean age 57.9±12.1 years, male 30.0%). Low aldosterone group had an increased left ventricular diastolic dimension compared with high aldosterone group (52.2±8.4 vs. 50.3±5.2 mm, p=0.033). The E/e' ratio and the proportion of LVDD were significantly higher in the low aldosterone group than the high aldosterone group. Multivariate logistic regression revealed that low log-aldosterone (odds ratio (OR) 0.403; 95% confidence interval (CI) 0.188-0.862) and large left atrial dimension (OR 1.308; 95% CI 1.114-1.536) were independent risk factors for LVDD. During the mean follow-up period of 5.2 years, the cumulative incidence rates of CV mortality were significantly higher in low aldosterone group (log-rank test, p=0.027). In addition, cox regression analysis demonstrated that low serum aldosterone was an independent predictor of CV mortality in HD patients (hazard ratio 0.505; 95% CI 0.294-0.869, p=0.014).

Conclusion

Low serum aldosterone was not only associated with LVDD but also an independent predictor of CV mortality among HD patients.

Funding

  • Clinical Revenue Support