title: Predictors of decreasing glomerular filtration rate and prevalence of chronic kidney disease after treatment of primary aldosteronism: renal outcome of 213 cases.
abstract: BACKGROUND
  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.
  
  
  METHODS
  This was a 12-month prospective study of patients with PA treated at Tohoku University Hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Division of Nephrology, Endocrinology, and Vascular Medicine (Y.I., R.M., M.K., Y.O., S.I., F.S.) and Departments of Radiology (K.T., K.S.), Urology (Y.A.), and Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai 980-8574, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Iwakura
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimoto
authors.forename: Masataka
authors.initials: M
authors.lastname: Kudo
authors.forename: Yoshikiyo
authors.initials: Y
authors.lastname: Ono
authors.forename: Kei
authors.initials: K
authors.lastname: Takase
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Seiji
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Ito
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Satoh
mesh_terms: D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000451:Mineralocorticoid Receptor Antagonists