Predictors of Decreasing Glomerular Filtration Rate and Prevalence of Chronic Kidney Disease After Treatment of Primary Aldosteronism: Renal Outcome of 213 Cases
Predictors of Decreasing Glomerular Filtration Rate and Prevalence of Chronic Kidney Disease After Treatment of Primary Aldosteronism: Renal Outcome of 213 Cases
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DOI：
10.1210/jc.2013-2180
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发表时间：
2014-05-01
影响因子：
5.8
通讯作者：
Satoh, Fumitoshi
中科院分区：
文献类型：
--
作者：
Iwakura, Yoshitsugu;Morimoto, Ryo;Satoh, Fumitoshi
背景：在原发性醛固酮增多症 (PA) 中，醛固酮过多导致的肾小球高滤过被认为低估了实际的肾损伤。目的：我们的目标是确定 PA 中慢性肾脏病 (CKD) 的患病率，并确定治疗后估计肾小球滤过率 (eGFR) 下降的预测因素。设计和背景：这是一项针对在东北大学医院接受治疗的 PA 患者的为期 12 个月的前瞻性研究。患者和干预措施：所有患者均按照以下标准进行治疗：肾上腺静脉采样结果； 102 例醛固酮腺瘤患者接受肾上腺切除术，111 例双侧醛固酮增多症患者接受盐皮质激素受体拮抗剂治疗。主要指标：干预后 1 个月和 12 个月测定电解质、血压和肾功能指标。结果：血压、尿白蛋白排泄量（UAE）和 eGFR 在 PA 治疗后 1 个月显着下降，但没有进一步下降12个月大时。首次就诊时，产生醛固酮的腺瘤中 CKD 的患病率为 15.7%，双侧醛固酮增多症中的 8.1%，在研究结束时分别增加至 37.1% 和 28.3%（P < .0001）。多变量回归分析显示，较高的UAE和较低的血清钾水平是干预后eGFR下降的独立预测因素。结论：这项大型队列研究表明，治疗后PA中CKD的患病率增加，并且首次就诊时较高的UAE和较低的血清钾水平是PA治疗后eGFR下降的预测因素。为了防止干预后 eGFR 大幅下降，PA 患者应在发展为严重蛋白尿和低钾血症之前进行诊断。
Context: In primary aldosteronism (PA), glomerular hyperfiltration due to excessive aldosterone is considered to underestimate actual renal damage.Objective: Our objectives were to determine the prevalence of chronic kidney disease (CKD) in PA and identify the predictors of decreasing estimated glomerular filtration rate (eGFR) after treatment.Design and Setting: This was a 12-month prospective study of patients with PA treated at Tohoku University Hospital.Patients and Interventions: All patients were treated according to the results of adrenal venous sampling; 102 patients with aldosterone-producing adenoma underwent adrenalectomy, and 111 with bilateral hyperaldosteronism were treated with mineralocorticoid receptor antagonists.Main Outcome Measures: Electrolytes, blood pressure, and indicators of renal function were determined at 1 and 12 months after intervention.Results: Blood pressure, urinary albumin excretion (UAE), and eGFR, which significantly decreased at 1 month after treatment of PA, did not further decrease at 12 months. Prevalence of CKD, which was 15.7% in aldosterone-producing adenoma and 8.1% in bilateral hyperaldosteronism at the first visit, increased to 37.1% and 28.3%, respectively, at the end of study (P < .0001). Multivariate regression analysis revealed that higher UAE and lower serum potassium levels were found to be independent predictors of decreasing eGFR after intervention.Conclusions: This large cohort study shows that the prevalence of CKD in PA was increased after treatment and that higher UAE and lower serum potassium levels at the first visit were predictors of decreasing eGFR after treatment of PA. To prevent a large decrease of eGFR after intervention, PA patients should be diagnosed before evolution to severe albuminuria and hypokalemia.