Renal Outcomes in Medically and Surgically Treated Primary Aldosteronism.
Renal Outcomes in Medically and Surgically Treated Primary Aldosteronism.
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DOI：
10.1161/hypertensionaha.118.11568
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发表时间：
2018-09
期刊：
影响因子：
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通讯作者：
Vaidya A
中科院分区：
文献类型：
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作者：
Hundemer GL;Curhan GC;Yozamp N;Wang M;Vaidya A
终生使用盐皮质激素受体拮抗剂(MRAs)或外科肾上腺切除术是治疗原发性醛固酮增多症(PA)的推荐方法。目前尚不清楚这些治疗方法是否会降低肾脏疾病的风险。我们对接受MRAS治疗的PA患者(N=400)或手术切除肾上腺的患者(N=120)以及年龄和估计的肾小球滤过率(EGFR)匹配的原发性高血压患者(N=15,474)进行了回顾性队列研究，以确定慢性肾脏疾病和纵向EGFR下降的风险。尽管血压相似，接受MRAS治疗的PA患者发生慢性肾脏疾病的风险高于高血压患者(调整后的HR为1.63[95%CI为1.33，1.99])。相应地，接受MRAS治疗的PA患者调整后的EGFR年降幅大于高血压患者(−1.6[95%CI−1.4，−1.8]vs−0.9[95%CI−0.9，−1.0]毫升/分钟/1.73m2/年，p<；0.001)。相比之下，接受手术肾上腺切除术的单侧PA患者与原发性高血压患者相比，在发生慢性肾脏疾病的风险或EGFR年下降方面没有显著差异。在接受MRAS治疗的PA糖尿病患者中，与高血压患者相比，发生蛋白尿的风险更高(调整后的HR为2.52[95%CI为1.28，4.96])。与原发性高血压相比，PA的MRA治疗与发生慢性肾脏疾病的风险更高，而外科肾上腺切除术可能会降低这种风险。如果可能，根治性手术肾上腺切除术在预防PA肾脏疾病方面可能优于终生MRA疗法。
Lifelong therapy with mineralocorticoid receptor antagonists (MRAs) or surgical adrenalectomy are the recommended treatments for primary aldosteronism (PA). Whether these treatments mitigate the risk for kidney disease remains unknown. We performed a retrospective cohort study of patients with PA treated with MRAs (N=400) or surgical adrenalectomy (N=120), and age- and estimated glomerular filtration rate (eGFR)-matched patients with essential hypertension (N=15,474) to determine risk for chronic kidney disease and longitudinal eGFR decline. Despite similar blood pressures, patients with PA treated with MRAs had a higher risk for incident chronic kidney disease compared with essential hypertension patients (adjusted HR 1.63 [95% CI 1.33, 1.99]). Correspondingly, the adjusted annual decline in eGFR was greater in PA patients treated with MRAs compared with essential hypertension patients (−1.6 [95% CI −1.4, −1.8] vs. −0.9 [95% CI −0.9, −1.0] mL/min/1.73 m2/year, p < 0.001). In contrast, patients with unilateral PA treated with surgical adrenalectomy had no significant difference in risk for incident chronic kidney disease or in annual decline in eGFR compared with essential hypertension patients. Among PA patients with diabetes treated with MRAs, there was a higher risk for incident albuminuria compared with essential hypertension (adjusted HR 2.52 [95% CI 1.28, 4.96]). MRA therapy in PA is associated with higher risk for developing chronic kidney disease, when compared with essential hypertension, and surgical adrenalectomy may mitigate this risk. When possible, curative surgical adrenalectomy may be superior to lifelong MRA therapy in preventing kidney disease in PA.