Effects of Treating Primary Aldosteronism on Renal Function

Area of Science:

• Nephrology
• Endocrinology

Background:

• Longstanding primary aldosteronism (PA) has detrimental effects on renal function, often unrecognized until treatment initiation.
• PA is hypothesized to cause relative glomerular hyperfiltration, leading to estimated glomerular filtration rate (eGFR) decline post-treatment.

Purpose of the Study:

• To identify predictors of eGFR decline and ultimate renal function after PA treatment.
• To assess the relationship between aldosterone levels and renal function changes.

Main Methods:

• Retrospective study of 134 PA patients.
• Analysis of clinical characteristics and eGFR before and 6 months after treatment (adrenalectomy or spironolactone).
• Multiple regression analysis to determine predictors of eGFR decline and attained renal function.

Main Results:

• Mean eGFR declined by 15.3±14.2 mL/min post-treatment.
• Independent predictors of eGFR decline included pretreatment plasma aldosterone, eGFR, plasma renin, and plasma potassium.
• Pretreatment plasma aldosterone, age, eGFR, and plasma potassium predicted ultimate attained eGFR.

Conclusions:

• Findings support the hypothesis that elevated aldosterone levels contribute to relative glomerular hyperfiltration.
• The severity of pretreatment aldosterone excess is a key risk factor for renal function decline in PA patients.