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Abstract: FR-PO736

Primary Aldosteronism in CKD Increases CV Risk and Death Independent of Adrenalectomy vs. Medical Management

Session Information

Category: Hypertension and CVD

  • 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials

Authors

  • Cohen, Debbie L., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Wachtel, Heather, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Vaidya, Anand, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Hundemer, Gregory L., Ottawa Hospital, Ottawa, Ontario, Canada
  • Tezuka, Yuta, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Turcu, Adina, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Cohen, Jordana B., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
Background

Primary aldosteronism (PA) is common and is associated with increased cardiovascular (CV) risk. Diagnosis and treatment of PA in CKD is often deferred for safety and efficacy concerns. Aim was to assess clinical outcomes in patients with confirmed PA and underlying CKD.

Methods

We conducted a retrospective cohort study of patients with biochemical PA and eGFR < 60 cc/min/1.73m2 from 3 academic medical centers, who underwent adrenal vein sampling (AVS) between 2009-2019. Primary outcomes were BP control and number of antihypertensive medications (AHM). Secondary outcomes included CV and renal clinical events and all-cause mortality.

Results

Of 239 patients, 159 lateralized on AVS (67%); 158 (66 %) underwent adrenalectomy and 81 (34%) were treated medically. Mean (SD) age was 57 (10) years, 33% were female with mean BMI of 33 (6) kg/m2. At baseline 1/3 had DM and CVD with mean serum values: K 3.9 (0.6) mmol/L, creatinine 1.9 (4.5) mg/dL and eGFR (2021 CKD-EPI without race) 54 (21) mL/min; 49% of subjects were on K supplements with 47% receiving K sparing diuretics. Subjects were followed for a median of 4.5 years. At 5 years mean BP decreased from 149/85 to 131/78 mm Hg and serum K increased from 3.9 to 4.2 mmol/L. Subjects who underwent adrenalectomy vs. medical management (MM) had 3.5 mm Hg lower SBP (p = 0.022) and required 1.8 fewer AHM at 5 years (p < 0.001). Every SD higher baseline eGFR (~20 mL/min/1.73m2) was associated with a 2 mm Hg lower SBP and reduced AHM requirement. Clinical event rates were high: MI 12(5%), TIA 11(5%), CHF 14(6%), Afib 21 (9%), dialysis 15(6%), death 23(10%). Using Cox models baseline non race-based eGFR was significantly associated with an increase in RRT and death even after adjustment for age, sex, CKD and DM (Table). No difference in clinical outcomes was detected if patients had adrenalectomy vs MM.

Conclusion

PA patient with CKD have a high risk for incident CV events, progression to RRT and death. PA patients with higher baseline eGFR had greater reductions in BP and AHM and are more likely to respond favorably to PA therapy, regardless if treated with adrenalectomy or MM.