Association Between Acute Fall in Estimated Glomerular Filtration Rate After Treatment for Primary Aldosteronism and Long-Term Decline in Renal Function
Association Between Acute Fall in Estimated Glomerular Filtration Rate After Treatment for Primary Aldosteronism and Long-Term Decline in Renal Function
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DOI：
10.1161/hypertensionaha.119.13131
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发表时间：
2019-09-01
期刊：
影响因子：
8.3
通讯作者：
Naruse, Mitsuhide
中科院分区：
文献类型：
--
作者：
Kobayashi, Hiroki;Abe, Masanori;Naruse, Mitsuhide
原发性醛固酮增多症导致肾小球超滤后肾结构损伤，原发性醛固酮增多症特异性治疗导致估计肾小球滤过率（eGFR）急性下降。我们在日本原发性醛固酮增多症多中心研究的回顾性队列中研究了这种变化是否影响长期eGFR斜率。我们根据治疗史将原发性醛固酮增多症患者分为肾上腺切除术组（n=202）和MR（盐皮质激素受体）拮抗剂组（n=303），并分析初始eGFR下降与长期eGFR斜率之间的相关性。在两组中，年龄增加、低血清钾水平、高eGFR和高血浆醛固酮水平是eGFR初始大幅下降的独立预测因素。我们基于初始eGFR下降的三分位数分析显示，在MR拮抗剂组中，初始eGFR下降较小的患者的长期eGFR斜率显著大于初始下降较大的患者（三分位数1与2，P=0.025;三分位数1与3，P=0.017）。肾上腺切除术组未发现这些相关性。因此，开始MR拮抗剂治疗时eGFR的急性下降越小，长期eGFR下降的速率越大。虽然原发性醛固酮增多症特异性治疗引起的eGFR急性下降偶尔是一个临床问题，但我们的研究结果强调了急性下降对长期肾脏结局的有利影响。
Primary aldosteronism causes renal structural damage after glomerular hyperfiltration, and primary aldosteronism-specific treatment leads to an acute fall in estimated glomerular filtration rate (eGFR). We investigated whether this change affected the long-term eGFR slope in a retrospective cohort from the multicenter Japan Primary Aldosteronism Study. We allocated patients with primary aldosteronism to the adrenalectomy (n=202) and MR (mineralocorticoid receptor) antagonist (n=303) groups based on their treatment history and analyzed the association between the initial eGFR fall and long-term eGFR slope. The increased age, low serum potassium levels, high eGFR, and high plasma aldosterone levels were independent predictors for a large initial eGFR fall in both groups. Our analysis of tertiles based on the initial eGFR fall revealed that in the MR antagonist group, patients with a small initial eGFR fall had a significantly steeper long-term eGFR slope than those with a large initial fall (tertile 1 versus 2, P=0.025; tertile 1 versus 3, P=0.017). These associations were not identified in the adrenalectomy group. Thus, the smaller the acute fall in eGFR by initiation of MR antagonists, the greater was the rate of long-term eGFR decline. While the acute fall in eGFR induced by primary aldosteronism-specific treatment is occasionally a clinical concern, our findings highlight the favorable implications of the acute fall with respect to long-term renal outcomes.