Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

Fourkiotis, Verena; Vonend, Oliver; Diederich, Sven; Fischer, Evelyn; Lang, Katharina; Endres, Stephan; Beuschlein, Felix; Willenberg, Holger S.; Rump, Lars Christian; Allolio, Bruno; Reincke, Martín; Quinkler, Marcus

doi:10.1530/eje-12-0631

Cited by 61 publications

(46 citation statements)

References 44 publications

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“…The German Conn's Registry (www.conn-register.de) is a multi-center database analyzing comorbidities and longterm outcome of patients with PA (4,13,14). Since the initiation of the prospective phase in October 2008, all patients actively treated within the centers were entered in a common database after pseudonymization (15).…”

Section: Design and Patientsmentioning

confidence: 99%

Post-saline infusion test aldosterone levels indicate severity and outcome in primary aldosteronism

Weigel

Riester

Hanslik

et al. 2015

European Journal of Endocrinology

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Objective: The saline infusion test (SIT) is widely used as a confirmatory test for primary aldosteronism (PA). SIT results are judged as follows: post-test aldosterone levels !50 ng/l exclude PA, whereas levels O50 ng/l confirm PA. We hypothesized that post-SIT aldosterone concentrations indicate the severity of PA and might predict outcome. Design: The study includes 256 PA patients of the German Conn's Registry who prospectively underwent SIT. The data of 126 patients with complete follow-up of 1.2G0.3 years after diagnosis were analyzed. The patients were divided into two groups with post-SIT aldosterone levels of 50-100 ng/l (group 1; nZ38) and of O100 ng/l (group 2; nZ88). Results: Patients in group 2 had a significantly shorter duration of hypertension (7.5 vs 11.7 years (median), PZ0.014), higher systolic blood pressure (BP; 151G16 vs 143G17 mmHg, PZ0.036), lower serum potassium (3.3G0.6 vs 3.5G0.4 mmol/l, PZ0.006), higher 24-h urine protein excretion (7.4 vs 5.4 mg/dl (median), PZ0.012), and were more often female (PZ0.038). They showed more often unilateral disease (P!0.005) with larger tumors (14G10 vs 7G10 mm, PZ0.021), underwent more often adrenalectomy (75% vs 37%, P!0.005), required a lower number of antihypertensive drugs after adrenalectomy (1.2G1.2 vs 2.5G1.4, PZ0.001), had a faster normalization of urinary protein excretion (with medical treatment PZ0.049; with Adx P!0.005) at follow-up, and more frequently underlying well-characterized mutation (PZ0.047). Conclusions: PA patients with post-SIT aldosterone levels of O100 ng/l have a more rapid development of PA caused more frequently by unilateral disease with larger aldosterone-producing adenomas. However, this group of patients may have a significantly better outcome following specific treatment.

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Section: Design and Patientsmentioning

confidence: 99%

Post-saline infusion test aldosterone levels indicate severity and outcome in primary aldosteronism

Weigel

Riester

Hanslik

et al. 2015

European Journal of Endocrinology

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“…50 Five other studies, with spironolactone uptitrated as needed and tolerated, revealed effects no different from those of surgery. [44][45][46]48,53,55 PA patients treated with spironolactone or amiloride experience an improvement in wellbeing similar to that observed after adrenalectomy, although these effects appear to be established more slowly. 86 …”

Section: Outcomes Of Drug-based Treatmentmentioning

confidence: 81%

“…40 They are most marked in patients with unilateral PA 41,42 and are reversed within one month of adrenalectomy (Figure 1). 40,[43][44][45][46][47][48][49][50][51][52][53][54][55] Hemodynamic stress and hyperaldosteronism per se lead to chronic structural damage in the long run. 45,56 PA patients have been reported to display a certain level of insulin resistance, which may improve after adrenalectomy.…”

Section: Outcomes Of Adrenalectomy In Unilateral Pamentioning

confidence: 99%

“…36,37 The relative glomerular hyperfiltration and microalbuminuria of PA patients are corrected on specific drugs (Figure 1). 40,[44][45][46]50,51,[53][54][55] Spironolactone was found to be less effective than surgery for achieving this end in one study using a fixed low dose (50 mg/day). 50 Five other studies, with spironolactone uptitrated as needed and tolerated, revealed effects no different from those of surgery.…”

Section: Outcomes Of Drug-based Treatmentmentioning

confidence: 99%

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Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Steichen

Lorthioir

Zinzindohoué

et al. 2015

Advances in Chronic Kidney Disease

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Treatments for primary aldosteronism (PA) aim to correct or prevent the deleterious consequences of hyperaldosteronism: hypertension, hypokalemia and direct target organ damage. Patients with unilateral PA considered fit for surgery can undergo laparoscopic adrenalectomy, which significantly decreases blood pressure and medications in most cases, and cures hypertension in about 40%. Mineralocorticoid receptor antagonists (MRA) are used to treat patients with bilateral PA and those with unilateral PA if surgery is not possible or not desired. Spironolactone is more potent than eplerenone, but high doses are poorly tolerated in men. MRA can be replaced or complemented with epithelial sodium channel blockers, such as amiloride. Thiazide diuretics and calcium channel blockers are used when the first-line drugs are insufficient to control blood pressure. Dietary sodium restriction should be implemented in all cases, because the deleterious consequences of hyperaldosteronism are dependent on salt loading. Several studies comparing the results of surgery and MRA have reported no differences in terms of blood pressure, serum potassium concentration or cardiovascular and renal outcomes, although the benefits of treatment tend to be observed sooner with surgery.PA patients display relative glomerular hyperfiltration, which is reversed by specific treatment, revealing chronic kidney disease in 30% of patients. However, further kidney damage is prevented by the treatment of PA. Clinical summary-The goals of treatment are the normalization of serum potassium concentration, blood pressure control and prevention of the direct effects of excess aldosterone on target organs. 3-The non-surgical treatment of PA is based on mineralocorticoid receptor antagonists and dietary sodium restriction.-Epithelial sodium channel blockers are used when mineralocorticoid receptor antagonists are not well tolerated; thiazide diuretics and calcium channel blockers are used when blood pressure control is insufficient with the first-line treatment.-Laparoscopic adrenalectomy is safe and decreases BP and medication requirements in patients with unilateral PA; drug-based treatments are appropriate in cases in which surgery is inappropriate or not desired.

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“…A short-term (1 year) study suggested superiority of surgery over medical treatment with regard to glomerular filtration rate and proteinuria [32]. However, long-term (> 5 years) renal benefit of medical treatment seems not inferior to surgery [33][34][35].…”

Section: Infraclinical Renal Damagementioning

confidence: 99%