title: Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism.
abstract: OBJECTIVE
  Primary aldosteronism (PA) has deleterious effects on kidney function independent of blood pressure levels. Up to now, data on effectiveness of different PA therapies regarding renal function are scarce.
  
  
  METHODS
  This prospective multi-center study included 29 patients with newly diagnosed PA evaluated before and 1 year after treatment initiation, and a second cohort including 119 patients who were evaluated 5.3 and 6.8 years after treatment initiation. Glomerular filtration rate (GFR), spot urine albumin excretion/urinary creatinine (UAE/Ucrea) ratio, biochemical parameters, and 24-h blood pressure were measured. In a larger cross-sectional cohort, renal function was evaluated depending on the type of treatment (adrenalectomy (ADX; n=86); spironolactone (n=65); and eplerenone (n=18)).
  
  
  RESULTS
  GFR and UAE/Ucrea ratio significantly decreased in newly diagnosed PA patients after treatment initiation. In the second cohort, GFR and UAE/Ucrea ratio did not change during study period, and blood pressure was well controlled. In the larger cross-sectional cohort, no differences were seen in GFR and UAE/Ucrea ratio between PA patients on different treatment regimens. However, eplerenone treatment showed lower potassium levels and higher number of required antihypertensive medications.
  
  
  CONCLUSIONS
  Renal dysfunction with elevated albuminuria was seen in PA patients and was reversible after treatment initiation. Medical therapies with spironolactone or eplerenone seem to be as effective as ADX regarding renal function and blood pressure; however, sufficient daily doses need to be given.
authors.affiliation: Charité University Medicine Berlin, Berlin, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Fourkiotis
authors.forename: Oliver
authors.initials: O
authors.lastname: Vonend
authors.forename: Sven
authors.initials: S
authors.lastname: Diederich
authors.forename: Evelyn
authors.initials: E
authors.lastname: Fischer
authors.forename: Katharina
authors.initials: K
authors.lastname: Lang
authors.forename: Stephan
authors.initials: S
authors.lastname: Endres
authors.forename: Felix
authors.initials: F
authors.lastname: Beuschlein
authors.forename: Holger S
authors.initials: HS
authors.lastname: Willenberg
authors.forename: Lars C
authors.initials: LC
authors.lastname: Rump
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
authors.forename: Marcus
authors.initials: M
authors.lastname: Quinkler
mesh_terms: D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000652:urine; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000652:urine; D000077545:Eplerenone; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006929:Hyperaldosteronism / Q000188:drug therapy* / Q000601:surgery*; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000627:therapeutic use*
chemical_list: D013148:Spironolactone; D000077545:Eplerenone; D003404:Creatinine