Adrenal venous sampling for primary hyperaldosteronism in patients with concurrent chronic kidney disease

To assess the risk of developing contrast-induced nephropathy (CIN) and to evaluate the technical success of adrenal venous sampling (AVS) in patients with chronic kidney disease (CKD).

AVS was performed in 25 patients with primary hyperaldosteronism and concurrent CKD to distinguish between unilateral and bilateral adrenal disease. One of the 25 patients underwent repeat AVS, for a total of 26 samplings. All patients received a hydration protocol before and after the procedure. Acute kidney injury (AKI) (increase in creatinine of 0.5 mg/dL or>25% above baseline) and diagnostic yield were determined.

CKD was stage III in 20 patients (80%), stage IV in 4 patients (16%), and stage V in 1 patient (4%). Median contrast volume was 25 mL (range, 10-250 mL). Of 26 studies, 25 (96%) were diagnostic; the one nondiagnostic AVS was repeated with success. Despite their elevated risks, only 2 of 25 patients (8%) developed AKI, and neither patient required treatment.

AVS can be performed safely with a high degree of technical success and low risk of CIN in patients with primary hyperaldosteronism and concurrent advanced CKD.