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[Elevated serum aldosterone levels in dialysis patients: Are we underusing renin-angiotensin-aldosterone system
M J Fernández-Reyes1, S Velasco1, C Gutierrez1
1Servicio de Nefrología, Hospital General, Segovia, España.
Insights
Dialysis patients often have high serum aldosterone levels (SA), linked to lower blood pressure and activated plasma renin activity (PRA), not dialysis factors. Blocking renin-angiotensin-aldosterone system agents (BSRAA) are underused in heart disease patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Endocrinology
Context:
- Serum aldosterone (SA) is a cardiovascular risk marker.
- Dialysis patients represent a unique population with potential for altered hormonal regulation.
- Understanding SA in dialysis is crucial for managing cardiovascular risk.
Purpose:
- To analyze serum aldosterone (SA) levels in dialysis patients.
- To investigate the relationship between SA and dialysis characteristics, comorbidities, blood pressure, and BSRAA use.
- To identify factors associated with elevated SA in this population.
Summary:
- A high percentage of dialysis patients exhibit elevated SA levels, unrelated to dialysis specifics or comorbidities.
- Elevated SA was inversely correlated with systolic blood pressure (SBP) and directly with plasma renin activity (PRA).
- Systolic blood pressure (SBP) and activated PRA were identified as independent risk factors for elevated SA.
Impact:
- Highlights the prevalence of elevated SA in dialysis patients, suggesting a potential cardiovascular risk factor.
- Reveals underutilization of blocking renin-angiotensin-aldosterone system agents (BSRAA) in patients with heart disease history.
- Suggests SBP and PRA as key factors influencing SA levels in dialysis patients, guiding potential therapeutic strategies.
Abstract:
Serum aldosteronelevels (SA) are a marker of cardiovascular (CV) risk in the general population.
Objective:
To analyze SA levels in dialysis patients and its relationship with characteristics of dialysis; comorbidity; blood pressure and the use of blocking renin-angiotensin-aldosterone system agents (BSRAA).
Methods:
We determined SA in 102 patients: 81 on hemodialysis (HD) and 21 on peritoneal dialysis. Mean age 71.4±12 years; 54.9% male; 29.4% diabetics. Mean time on dialysis 59.3±67 months. In 44 HD patients plasma renin activity (PRA) was measured.
Results:
Mean SA was 72.6±114.9ng/dl (normal range 1.17-23.6ng/dl). A total of 57.8% of patients had above normal levels which were not related to dialysis characteristics or comorbidity. Only 21% of patients with heart failure and 19.2% with ischemic heart disease used BSRAA. A number of 25 patients treated with BSRAA had significantly lower levels of SA. There was an inverse correlation between AS and systolic blood pressure (SBP), and direct with PRA. The logistic regression analysis conducted to find SA levels above the median associated factors showed that SBP was the only independent risk variable in the overall population (OR 0.97; P=.022); in the 44 patients in whom PRA was determined this was the only independent risk factor (OR 2.24; P=.012).
Conclusions:
A high percentage of dialysis patients have elevated levels of SA that are associated to diminished SBP and activated PRA and not to dialysis characteristics. In patients with a history of heart disease we underuse BSRAA.
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