title: Serum aldosterone and death, end-stage renal disease, and cardiovascular events in blacks and whites: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study.
abstract: Prior studies have demonstrated that elevated aldosterone concentrations are an independent risk factor for death in patients with cardiovascular disease. Limited studies, however, have evaluated systematically the association between serum aldosterone and adverse events in the setting of chronic kidney disease. We investigated the association between serum aldosterone and death and end-stage renal disease in 3866 participants from the Chronic Renal Insufficiency Cohort. We also evaluated the association between aldosterone and incident congestive heart failure and atherosclerotic events in participants without baseline cardiovascular disease. Cox proportional hazards models were used to evaluate independent associations between elevated aldosterone concentrations and each outcome. Interactions were hypothesized and explored between aldosterone and sex, race, and the use of loop diuretics and renin-angiotensin-aldosterone system inhibitors. During a median follow-up period of 5.4 years, 587 participants died, 743 developed end-stage renal disease, 187 developed congestive heart failure, and 177 experienced an atherosclerotic event. Aldosterone concentrations (per SD of the log-transformed aldosterone) were not an independent risk factor for death (adjusted hazard ratio, 1.00; 95% confidence interval, 0.93-1.12), end-stage renal disease (adjusted hazard ratio, 1.07; 95% confidence interval, 0.99-1.17), or atherosclerotic events (adjusted hazard ratio, 1.04; 95% confidence interval, 0.85-1.18). Aldosterone was associated with congestive heart failure (adjusted hazard ratio, 1.21; 95% confidence interval, 1.02-1.35). Among participants with chronic kidney disease, higher aldosterone concentrations were independently associated with the development of congestive heart failure but not for death, end-stage renal disease, or atherosclerotic events. Further studies should evaluate whether mineralocorticoid receptor antagonists may reduce adverse events in individuals with chronic kidney disease because elevated cortisol levels may activate the mineralocorticoid receptor.
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.). Rajat.Deo@uphs.upenn.edu.
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.).
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.).
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Khan
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.).
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.).
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Zhang
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.).
authors.forename: Mary B
authors.initials: MB
authors.lastname: Leonard
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.).
authors.forename: Martin G
authors.initials: MG
authors.lastname: Keane
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.).
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.).
authors.forename: Susan
authors.initials: S
authors.lastname: Steigerwalt
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.).
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.).
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine (R.D., A.M.K.) and Department of Medicine, The Renal Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia (W.Y., X.Z., M.B.L., H.I.F.); Department of Medicine, Division of Nephrology, University of Washington, Seattle (N.B.); Division of Nephrology, The Children's Hospital of Philadelphia, PA (M.B.L.); Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (M.G.K.); Epidemiological Cardiology Research Center (E.Z.S.), Department of Epidemiology and Prevention (E.Z.S.), and Department of Internal Medicine, Cardiology Section (E.Z.S.), Wake Forest University School of Medicine, Winston Salem, NC; Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.S.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (M.G.S.); and Department of General Internal Medicine, San Francisco VA Medical Center, CA (M.G.S.).
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
mesh_terms: D000368:Aged; D000450:Aldosterone / Q000097:blood*; D044383:Black People; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality*; D012307:Risk Factors; D044465:White People
chemical_list: D000450:Aldosterone
keywords: aldosterone; death; heart failure; renal insufficiency, chronic
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