Kidney Week

Abstract: FR-OR021

Association of Primary Aldosteronism with Kidney Outcomes in Patients with Advanced CKD

Session Information

• CKD: Identifying Risks and Optimizing Outcomes
  November 07, 2025 | Location: Room 362A, Convention Center
  Abstract Time: 04:50 PM - 05:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Gyamlani, Geeta G., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Geeta G. Gyamlani, MD, FASN

• Shrestha, Prabin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Prabin Shrestha, PhD

• Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Keiichi Sumida, MD, PhD, MPH, FASN

• Adeboye, Adedamola M., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Adedamola M. Adeboye, MD, MBBS

• Kalantar-Zadeh, Kamyar, University of California Los Angeles, Los Angeles, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

Background

The prevalence of primary aldosteronism (PA+) among patients with advanced CKD remains unknown, with limited understanding of the associated risk for progression of CKD in this population.

Methods

In this nationwide cohort study of 102,477 US veterans who transitioned to dialysis between 2007 and 2014, we identified 2,524 (2.4%) patients who underwent screening for PA prior to transition to dialysis. We examined the association of PA+ (vs. PA-) and of serum aldosterone level with the decline in eGFR using linear mixed-effects models, adjusting for demographic and socioeconomic characteristics, blood pressure, comorbidities, medications and laboratory values including eGFR and serum potassium (K) concentration.

Results

The mean±SD of age, serum K and systolic blood pressure of the cohort were 63±11 years, 4.3±0.7 mmol/L and 154±29 mmHg, respectively; the median (25^th-75^th pctl) of eGFR was 27 (17-40) mL/min/1.73 m²; with 97% being male, 47% African American and 68% diabetic. Of the patients screened, 10.5% were PA+. The eGFR slopes were similar in PA+ and PA- patients (-2.06 vs -2.11 mL/min/1.73m²/year, respectively), and serum aldosterone level showed no association with eGFR decline (p = 0.5) (Table).

Conclusion

Primary aldosteronism is prevalent in patients with advanced CKD, but it is not associated with the risk of kidney disease progression. The lack of association with adverse kidney outcomes may be explained by successful treatment of PA (e.g., with mineralocorticoid receptor antagonists) in this population.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025ycr6wsjt