title: Hyperaldosteronism and cardiovascular risk in patients with autosomal dominant polycystic kidney disease.
abstract: Hypertension is commonly associated with autosomal dominant polycystic kidney disease (ADPKD), often discovered before the onset of renal failure, albeit the pathogenetic mechanisms are not well elucidated. Hyperaldosteronism in ADPKD may contribute to the development of insulin resistance and endothelial dysfunction, and progression of cardiorenal disease. The aim of study was to evaluate the prevalence of primary aldosteronism (PA) in ADPKD patients and identify some surrogate biomarkers of cardiovascular risk.We have enrolled 27 hypertensive ADPKD patients with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min, evaluating the renin-angiotensin-aldosterone system (RAAS), inflammatory indexes, nutritional status, homocysteine (Hcy), homeostasis model assessment-insulin resistance (HOMA-IR), mineral metabolism, microalbuminuria, and surrogate markers of atherosclerosis [carotid intima media thickness (cIMT), ankle/brachial index (ABI), flow mediated dilation (FMD), renal resistive index (RRI) and left ventricular mass index (LVMI)]. Furthermore, we have carried out the morpho-functional magnetic resonance imaging (MRI) with high-field 3 T Magnetom Avanto.We have divided patients into group A, with normal plasma aldosterone concentration (PAC) and group B with PA, present in 9 (33%) of overall ADPKD patients. Respect to group A, group B showed a significant higher mean value of LVMI, HOMA-IR and Hcy (P = 0.001, P = 0.004, P = 0.018; respectively), and a lower value of FMD and 25-hydroxyvitamin D (25-OH-VitD) (P = 0.037, P = 0.019; respectively) with a higher prevalence of non-dipper pattern at Ambulatory Blood Pressure Monitoring (ABPM) (65% vs 40%, P < 0.05) at an early stage of the disease.In this study, we showed a high prevalence of PA in ADPKD patients, associated to higher LVMI, HOMA-IR, Hcy, lower FMD, and 25-OH-VitD, considered as surrogate markers of atherosclerosis, compared to ADPKD patients with normal PAC values. Our results indicate a higher overall cardiovascular risk in ADPKD patients with inappropriate aldosterone secretion, and a screening for PA in all patients with ADPKD is recommended.
authors.affiliation: Department of Clinical Medicine, Sapienza University of Rome, Rome Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, Rome Cobellis Clinic, Tirreno SRL, Vallo della lucania, Sapri, Salerno Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome Department of Clinical and Experimental Sciences, University of Brescia, Brescia Department of Obstetrical-Gynecological Sciences and Urologic Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Lai
authors.forename: Luigi
authors.initials: L
authors.lastname: Petramala
authors.forename: Daniela
authors.initials: D
authors.lastname: Mastroluca
authors.forename: Emanuela
authors.initials: E
authors.lastname: Petraglia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Gaeta
authors.forename: Elena
authors.initials: E
authors.lastname: Indino
authors.forename: Valeria
authors.initials: V
authors.lastname: Panebianco
authors.forename: Mauro
authors.initials: M
authors.lastname: Ciccariello
authors.forename: Hossein H
authors.initials: HH
authors.lastname: Shahabadi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Galani
authors.forename: Claudio
authors.initials: C
authors.lastname: Letizia
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: D'Angelo
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006929:Hyperaldosteronism / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D007333:Insulin Resistance; D008279:Magnetic Resonance Imaging; D008297:Male; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications* / Q000503:physiopathology; D015995:Prevalence; D012084:Renin-Angiotensin System; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers