Risk factors associated with a low glomerular filtration rate in primary aldosteronism.
BACKGROUND
Primary aldosteronism (PA) is associated with vascular end organ damage.


OBJECTIVE
We evaluated the newly established German Conn's Registry for evidence of renal impairment and compared the data with those from hypertensive subjects of a population-based survey.


METHODS
We conducted a case-control study.


METHODS
A total of 408 patients with PA from the Conn's registry treated in five German centers were matched for age, sex, and body mass index in a 1:1 ratio with 408 hypertensive control subjects from the population-based F3 survey of the Kooperative Gesundheitsforschung in the region of Augsburg (KORA).


METHODS
We measured serum creatinine and calculated glomerular filtration rate (GFR).


RESULTS
The percentage of patients with a serum creatinine concentration above the normal range of 1.25 mg/dl was higher in patients with PA than in hypertensive controls (29 vs. 10%; P < 0.001). Regression analysis showed that age, male sex, low potassium, and high aldosterone concentrations were independent predictors of a lower GFR. Adrenalectomy reduced systolic blood pressure from a mean of 160 to 144 mm Hg. In parallel, we observed an increase in serum creatinine and a decrease of GFR from 71 to 64 ml/min (P < 0.001). A similar trend was seen after spironolactone treatment.


CONCLUSIONS
In a large cohort of patients with PA, markers of disease activity such as plasma aldosterone and serum potassium are independent predictors of a lower GFR. Specific interventions, such as adrenalectomy or spironolactone treatment, are associated with a further decline in GFR.
Reincke
Martin
M
Medizinische Klinik-Innenstadt, Ludwig-Maximilians-Universität München, 80336 München, Germany. martin.reincke@med.uni-muenchen.de.
Rump
Lars Christian
LC
Quinkler
Marcus
M
Hahner
Stephanie
S
Diederich
Sven
S
Lorenz
Reinhard
R
Seufert
Jochen
J
Schirpenbach
Caroline
C
Beuschlein
Felix
F
Bidlingmaier
Martin
M
Meisinger
Christa
C
Holle
Rolf
R
Endres
Stephan
S
D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006929:Hyperaldosteronism / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008901:Mineralocorticoids / Q000037:antagonists & inhibitors; D012307:Risk Factors
D008901:Mineralocorticoids; D003404:Creatinine