Long‐term effects of primary aldosteronism treatment on patients with primary aldosteronism and chronic kidney disease
Long‐term effects of primary aldosteronism treatment on patients with primary aldosteronism and chronic kidney disease
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原发性醛固酮增多症治疗对原发性醛固酮增多症合并慢性肾脏病患者的长期影响
DOI：
10.1111/cen.14849
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发表时间：
2022
影响因子：
3.2
通讯作者：
Yamada Tetsuya
中科院分区：
文献类型：
--
作者：
Nakano Yujiro;Murakami Masanori;Hara Kazunari;Fukuda Tatsuya;Horino Masato;Takeuchi Akira;Niitsu Yoshihiro;Shiba Kumiko;Tsujimoto Kazutaka;Komiya Chikara;Yokoyama Minato;Ikeda Kenji;Yoshimoto Takanobu;Fujii Yasuhisa;Yamada Tetsuya
目的原发性醛固酮增多症(PA)是继发性高血压的主要原因，并与慢性肾损害有关。经肾上腺切除术(ADX)或糖皮质激素受体拮抗剂(MRA)治疗后，肾小球滤过率(GFR)迅速下降，并保持稳定。在这项单中心的回顾性研究中，对107例PA患者的肾小球滤过率的急性和慢性变化进行了研究，其中49例治疗后肾小球滤过率为 <； 为60 /m in/1.73 m2。结果慢性肾脏病组(N= 31)治疗后1个月肾小球滤过率下降为−20.1 ± 8.2min/ /1.73 m2。多因素分析显示，治疗前EGFR和血浆醛固酮浓度是ADX后EGFR急性下降的独立预测因素。治疗后慢性肾脏病组(N= 18)用药后1个月的EGFR值为−9.2min± 5.9min/min/1.73min m2。多因素分析显示，高血压病程和治疗前EGFR是ADX治疗后EGFR急性下降的独立预测因素。20例慢性肾功能不全患者(N= 12ADX，n= 8MRA)治疗后随访5年以上，随访7(6，8)年，EGFR无明显下降，两种治疗方式之间也无明显差异。
ObjectivePrimary aldosteronism (PA) is a major cause of secondary hypertension and is associated with chronic renal injury. The glomerular filtration rate (GFR) in PA rapidly decreases after the removal of glomerular hyperfiltration due to aldosterone excess by adrenalectomy (ADX) or mineralocorticoid receptor antagonist (MRA) treatment and is stable in the long term. However, the effects of these treatments on the long‐term renal function of PA patients with chronic kidney disease (CKD) is not well understood.Design and PatientsIn this single‐center, retrospective study, acute and chronic changes in the estimated GFR (eGFR) were examined in 107 patients with PA, including 49 patients with post‐treatment CKD defined as eGFR < 60 ml/min/1.73 m2.ResultsThe reduction in eGFR observed 1 month after ADX in the CKD group (N= 31) was −20.1 ± 8.2 ml/min/1.73 m2. Multivariate analysis showed that pre‐treatment eGFR and plasma aldosterone concentration were independent predictive factors of the acute reduction in eGFR after ADX. The reduction of eGFR observed 1 month after MRA administration in the post‐treatment CKD group (N= 18) was −9.2 ± 5.9 ml/min/1.73 m2. Multivariate analysis showed that the duration of hypertension and pre‐treatment eGFR were independent predictive factors of the acute reduction in eGFR after ADX administration. In 20 patients with CKD (N= 12 ADX andN= 8 MRA) followed for more than 5 years post‐treatment, there was no further significant decline in eGFR over a follow‐up period of 7 (6, 8) years nor any difference between the two treatment modalities.ConclusionsOur study suggests that treatment of PA in stage 3 CKD is safe and useful in preventing renal injury.
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影响因子：
13.6
作者：
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发表时间：
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La Tunisie medicale
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