Kidney impairment in primary aldosteronism

Wu, Vin‐Cent; Yang, Shan-Yi; Lin, Jou‐Wei; Cheng, Bor‐Wen; Kuo, Chin‐Chi; Tsai, Chia Ti; Chu, Tzong‐Shinn; Huang, Kuo‐How; Wang, Shuo-Meng; Lin, Yen‐Hung; Chiang, Chih‐Kang; Chang, Hung-Wei; Lin, Chien‐Yu; Lin, Lian‐Yu; Chiu, Jainn-Shiun; Hu, Fu‐Chang; Chueh, Shih-Chieh; Ho, Yen Teng; Liu, Kao–Lang; Lin, Shuei‐Liong; Yen, Ruoh‐Fang; Wu, Kwan‐Dun

doi:10.1016/j.cca.2011.02.018

Cited by 116 publications

(114 citation statements)

References 38 publications

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“…In our prospective study setting, we found a decline in GFR in early phase after initiation of the treatment. This observation has been explained by an aldosterone-induced hyperfiltration, which is abolished after treatment (35,36,37), and was shown recently also for cystatin C-based estimations of BP, blood pressure; UAE/UCrea, spot urine albumin excretion/ urinary creatinine. Normal ranges (SI units shown in brackets): sodium, 134-145 mmol/l; potassium, 3.4-5.2 mmol/l; urea, 10-50 mg/dl; UAE/UCrea, !20 mg/g.…”

Section: Discussionmentioning

confidence: 53%

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

Fourkiotis

Vonend²,

Diederich³

et al. 2013

European Journal of Endocrinology

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Objective: Primary aldosteronism (PA) has deleterious effects on kidney function independent of blood pressure levels. Up to now, data on effectiveness of different PA therapies regarding renal function are scarce. Design and methods: This prospective multi-center study included 29 patients with newly diagnosed PA evaluated before and 1 year after treatment initiation, and a second cohort including 119 patients who were evaluated 5.3 and 6.8 years after treatment initiation. Glomerular filtration rate (GFR), spot urine albumin excretion/urinary creatinine (UAE/Ucrea) ratio, biochemical parameters, and 24-h blood pressure were measured. In a larger cross-sectional cohort, renal function was evaluated depending on the type of treatment (adrenalectomy (ADX; nZ86); spironolactone (nZ65); and eplerenone (nZ18)). Results: GFR and UAE/Ucrea ratio significantly decreased in newly diagnosed PA patients after treatment initiation. In the second cohort, GFR and UAE/Ucrea ratio did not change during study period, and blood pressure was well controlled. In the larger cross-sectional cohort, no differences were seen in GFR and UAE/Ucrea ratio between PA patients on different treatment regimens. However, eplerenone treatment showed lower potassium levels and higher number of required antihypertensive medications. Conclusions: Renal dysfunction with elevated albuminuria was seen in PA patients and was reversible after treatment initiation. Medical therapies with spironolactone or eplerenone seem to be as effective as ADX regarding renal function and blood pressure; however, sufficient daily doses need to be given.

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Section: Discussionmentioning

confidence: 53%

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

Fourkiotis

Vonend²,

Diederich³

et al. 2013

European Journal of Endocrinology

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“…If unable to have an age-adjusted control group, authors should at the minimum select from the literature a control group with characteristics similar to those of their participants and with similar GFR evaluation methods. Among the four studies reporting a GH threshold ,2 SDs of the median (of this systematic review), three used their own control group, with age adjusted to their study population (26)(27)(28). These three studies were performed in Japan and Taiwan, and GFR was indexed for body surface area, which is lower in Asian population (29).…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Glomerular Hyperfiltration Assessment and Definition in the Medical Literature

Cachat

Combescure

Cauderay³

et al. 2015

Clinical Journal of the American Society of Nephrology

150

138

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Background and objectives Evaluation of glomerular hyperfiltration (GH) is difficult; the variable reported definitions impede comparisons between studies. A clear and universal definition of GH would help in comparing results of trials aimed at reducing GH. This study assessed how GH is measured and defined in the literature.Design, setting, participants, & measurements Three databases (Embase, MEDLINE, CINAHL) were systematically searched using the terms "hyperfiltration" or "glomerular hyperfiltration". All studies reporting a GH threshold or studying the effect of a high GFR in a continuous manner against another outcome of interest were included.Results The literature search was performed from November 2012 to February 2013 and updated in August 2014. From 2013 retrieved studies, 405 studies were included. Threshold use to define GH was reported in 55.6% of studies. Of these, 88.4% used a single threshold and 11.6% used numerous thresholds adapted to participant sex or age. In 29.8% of the studies, the choice of a GH threshold was not based on a control group or literature references. After 2004, the use of GH threshold use increased (P,0.001), but the use of a control group to precisely define that GH threshold decreased significantly (P,0.001); the threshold did not differ among pediatric, adult, or mixedage studies. The GH threshold ranged from 90.7 to 175 ml/min per 1.73 m 2 (median, 135 ml/min per 1.73 m 2 ).Conclusion Thirty percent of studies did not justify the choice of threshold values. The decrease of GFR in the elderly was rarely considered in defining GH. From a methodologic point of view, an age-and sex-matched control group should be used to define a GH threshold.

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“…Although the PTS provides convenience and speed of transport, hemolysis of blood specimens and preanalytical variation have been related to excessive acceleration forces and prolonged time/ distance traveled in the PTS (1)(2)(3)(4)(5). As a result, regular assessment of 3-axis acceleration (i.e., forces) in PTSs has been recommended in an article in this journal (5 ). An editorial related to that article suggested that products designed for PTS assessment may become commercially available and capable of recording g-forces in PTSs (2 ).…”

Section: To the Editormentioning

confidence: 99%