title: Kidney impairment in primary aldosteronism.
abstract: BACKGROUND
  Kidney impairment is noted in primary aldosteronism (PA), and probably initiated by glomerular hyperfiltration.
  
  
  METHODS
  A prospectively defined survey was conducted on 602 patients who were suspected of PA in the multiple-center Taiwan Primary Aldosteronism Investigation (TAIPAI) database. Estimated glomerular filtration rate (eGFR) was calculated and followed up at 1 yr after treatment.
  
  
  RESULTS
  The diagnosis of PA was confirmed in 330 patients. Among them 17% of these patients had kidney impairment (eGFR<60 ml/min/1.73 m²). Patients with PA had a higher prevalence of estimated hyperfiltration than those with essential hypertension (EH) (14.5% vs. 7.0%, p=0.005). The eGFR independently predicted PA (OR, 1.017) in the propensity-adjusted multivariate logistic model. In PA, plasma renin activity and lower serum potassium (p=0.018) was correlated with kidney impairment (p=0.001), while this relationship was not significant in patients with EH. Either unilateral adrenalectomy or treatment of spironolactone for PA patients caused a decrease of eGFR (p<0.001). Pre-operative hypokalemia (p=0.013) and the long latency of hypertension (p=0.016) could enhance the significant decrease of eGFR after adrenalectomy.
  
  
  CONCLUSIONS
  Patients with aldosteronism had relative estimated hyperfiltration than patients with EH. Calculation of eGFR may increase the specificity in identifying patients with PA. Our findings demonstrate the correlation of serum potassium and renin with estimated hyperfiltration in PA and their relationship to kidney damage. These results provide a high priority for future renal protective strategies and methods for the early diagnosis and prompt treatment of PA.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.forename: Shao-Yu
authors.initials: SY
authors.lastname: Yang
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Bor-Wen
authors.initials: BW
authors.lastname: Cheng
authors.forename: Chin-Chi
authors.initials: CC
authors.lastname: Kuo
authors.forename: Chia-Ti
authors.initials: CT
authors.lastname: Tsai
authors.forename: Tzong-Shinn
authors.initials: TS
authors.lastname: Chu
authors.forename: Kuo-How
authors.initials: KH
authors.lastname: Huang
authors.forename: Shuo-Meng
authors.initials: SM
authors.lastname: Wang
authors.forename: Yen-Hung
authors.initials: YH
authors.lastname: Lin
authors.forename: Chih-Kang
authors.initials: CK
authors.lastname: Chiang
authors.forename: Hung-Wei
authors.initials: HW
authors.lastname: Chang
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Lian-Yu
authors.initials: LY
authors.lastname: Lin
authors.forename: Jainn-Shiun
authors.initials: JS
authors.lastname: Chiu
authors.forename: Fu-Chang
authors.initials: FC
authors.lastname: Hu
authors.forename: Shih-Chieh
authors.initials: SC
authors.lastname: Chueh
authors.forename: Yi-Luwn
authors.initials: YL
authors.lastname: Ho
authors.forename: Kao-Lang
authors.initials: KL
authors.lastname: Liu
authors.forename: Shuei-Liong
authors.initials: SL
authors.lastname: Lin
authors.forename: Ruoh-Fang
authors.initials: RF
authors.lastname: Yen
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
mesh_terms: D005919:Glomerular Filtration Rate; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D006973:Hypertension / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology*; D016015:Logistic Models; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D013148:Spironolactone / Q000627:therapeutic use
chemical_list: D013148:Spironolactone; D012083:Renin; D011188:Potassium