Aldosterone in chronic kidney disease and renal outcomes

Area of Science:

• Nephrology
• Endocrinology
• Cardiovascular Medicine

Background:

• Mineralocorticoid receptor (MR) antagonists show efficacy in slowing chronic kidney disease (CKD) progression in diabetic patients.
• Previous studies have not clarified the role of aldosterone or MR antagonism in non-diabetic individuals with CKD.

Purpose of the Study:

• To investigate the association between serum aldosterone concentrations and kidney disease progression in a large cohort of CKD patients.
• To determine if the association between aldosterone and CKD progression differs between patients with and without diabetes.

Main Methods:

• The Chronic Renal Insufficiency Cohort (CRIC) study included 3680 participants.
• Serum aldosterone concentrations were measured at baseline.
• CKD progression was defined as a 50% decline in estimated glomerular filtration rate (eGFR) or end-stage kidney disease.
• Cox proportional hazard models were used to assess associations.

Main Results:

• Higher baseline serum aldosterone concentrations were associated with lower eGFR, lower serum potassium, and greater urinary potassium and protein excretion.
• Over a median follow-up of 9.6 years, 1412 participants experienced CKD progression.
• Each doubling of serum aldosterone was associated with an 11% increased risk of CKD progression (HR 1.11, 95% CI 1.04-1.18).
• The highest quartile of serum aldosterone was linked to a 45% increased risk of CKD progression (HR 1.45, 95% CI 1.22-1.73) compared to the lowest quartile.
• This association remained significant regardless of diabetes status (P-interaction = 0.10).

Conclusions:

• Elevated serum aldosterone levels are independently associated with an increased risk of kidney disease progression in CKD patients.
• These findings support the use of mineralocorticoid receptor antagonists for delaying CKD progression.
• The results suggest that MR antagonists may also benefit patients with CKD who do not have diabetes.