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Hyperaldosteronism and cardiovascular risk in patients with autosomal dominant polycystic kidney disease

Silvia Lai1, Luigi Petramala, Daniela Mastroluca

  • 1Department of Clinical Medicine, Sapienza University of Rome, Rome Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, Rome Cobellis Clinic, Tirreno SRL, Vallo della lucania, Sapri, Salerno Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome Department of Clinical and Experimental Sciences, University of Brescia, Brescia Department of Obstetrical-Gynecological Sciences and Urologic Sciences, Sapienza University of Rome, Rome, Italy.

Medicine
|July 22, 2016
PubMed

Insights

Primary aldosteronism (PA) is common in autosomal dominant polycystic kidney disease (ADPKD) patients, linked to increased cardiovascular risk markers. Screening for PA in ADPKD patients is recommended to identify those at higher risk.

Area of Science:

  • Nephrology
  • Endocrinology
  • Cardiology

Background:

  • Hypertension is a common comorbidity in autosomal dominant polycystic kidney disease (ADPKD), often preceding renal failure.
  • The underlying mechanisms linking hypertension and ADPKD, particularly the role of hyperaldosteronism, require further elucidation.
  • Hyperaldosteronism may contribute to insulin resistance, endothelial dysfunction, and cardiorenal disease progression in ADPKD.

Purpose of the Study:

  • To determine the prevalence of primary aldosteronism (PA) in patients with ADPKD.
  • To identify surrogate biomarkers of cardiovascular risk associated with PA in ADPKD patients.
  • To investigate the association between PA and markers of atherosclerosis and metabolic dysfunction in ADPKD.

Main Methods:

  • Enrolled 27 hypertensive ADPKD patients with eGFR ≥ 60 mL/min.
  • Evaluated the renin-angiotensin-aldosterone system (RAAS), inflammatory markers, homocysteine (Hcy), HOMA-IR, mineral metabolism, and microalbuminuria.
  • Assessed surrogate markers of atherosclerosis including cIMT, ABI, FMD, RRI, LVMI, and utilized 3 Tesla MRI.

Main Results:

  • Primary aldosteronism (PA) was present in 33% of the studied ADPKD patients.
  • PA group showed significantly higher LVMI, HOMA-IR, and Hcy levels compared to the non-PA group.
  • The PA group exhibited lower FMD, lower 25-hydroxyvitamin D levels, and a higher prevalence of the non-dipper pattern on ABPM.

Conclusions:

  • A significant prevalence of PA exists in ADPKD patients, even at early stages of the disease.
  • PA in ADPKD is associated with adverse cardiovascular risk markers, including increased left ventricular mass index, insulin resistance, homocysteine, and endothelial dysfunction.
  • Screening for PA is recommended in all ADPKD patients to identify individuals with potentially higher cardiovascular risk due to inappropriate aldosterone secretion.

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