title: [Elevated serum aldosterone levels in dialysis patients: Are we underusing renin-angiotensin-aldosterone system blockers?]
abstract: Serum aldosteronelevels (SA) are a marker of cardiovascular (CV) risk in the general population.
  
  
  OBJECTIVE
  To analyze SA levels in dialysis patients and its relationship with characteristics of dialysis; comorbidity; blood pressure and the use of blocking renin-angiotensin-aldosterone system agents (BSRAA).
  
  
  METHODS
  We determined SA in 102 patients: 81 on hemodialysis (HD) and 21 on peritoneal dialysis. Mean age 71.4±12 years; 54.9% male; 29.4% diabetics. Mean time on dialysis 59.3±67 months. In 44 HD patients plasma renin activity (PRA) was measured.
  
  
  RESULTS
  Mean SA was 72.6±114.9ng/dl (normal range 1.17-23.6ng/dl). A total of 57.8% of patients had above normal levels which were not related to dialysis characteristics or comorbidity. Only 21% of patients with heart failure and 19.2% with ischemic heart disease used BSRAA. A number of 25 patients treated with BSRAA had significantly lower levels of SA. There was an inverse correlation between AS and systolic blood pressure (SBP), and direct with PRA. The logistic regression analysis conducted to find SA levels above the median associated factors showed that SBP was the only independent risk variable in the overall population (OR 0.97; P=.022); in the 44 patients in whom PRA was determined this was the only independent risk factor (OR 2.24; P=.012).
  
  
  CONCLUSIONS
  A high percentage of dialysis patients have elevated levels of SA that are associated to diminished SBP and activated PRA and not to dialysis characteristics. In patients with a history of heart disease we underuse BSRAA.
authors.affiliation: Servicio de Nefrología, Hospital General, Segovia, España. Electronic address: mfernandez@hgse.sacyl.es.
authors.forename: M J
authors.initials: MJ
authors.lastname: Fernández-Reyes
authors.affiliation: Servicio de Nefrología, Hospital General, Segovia, España.
authors.forename: S
authors.initials: S
authors.lastname: Velasco
authors.affiliation: Servicio de Nefrología, Hospital General, Segovia, España.
authors.forename: C
authors.initials: C
authors.lastname: Gutierrez
authors.affiliation: Análisis Clínicos, Hospital Universitario La Paz, Madrid, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Gonzalez Villalba
authors.affiliation: Servicio de Nefrología, Hospital General, Segovia, España.
authors.forename: M
authors.initials: M
authors.lastname: Heras
authors.affiliation: Servicio de Nefrología, Hospital General, Segovia, España.
authors.forename: A
authors.initials: A
authors.lastname: Molina
authors.affiliation: Servicio de Nefrología, Hospital General, Segovia, España.
authors.forename: R
authors.initials: R
authors.lastname: Callejas
authors.affiliation: Servicio de Nefrología, Hospital General, Segovia, España.
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez
authors.affiliation: Servicio de Nefrología, Hospital General, Segovia, España.
authors.forename: L
authors.initials: L
authors.lastname: Calle
authors.affiliation: Centro de Diálisis Los Olmos, FRIAT, Segovia, España.
authors.forename: V
authors.initials: V
authors.lastname: Lopes
keywords: Aldosterona; Dialysis; Diálisis; Renin-angiotensin-aldosterone system; Serum aldosterone; Sistema renina-angiotensina-aldosterona