Renal impairment is closely associated with plasma aldosterone concentration in patients with primary aldosteronism

Abstract

Objective Several clinical studies have reported that renal impairments are sometimes observed in patients with primary aldosteronism (PA). We analyzed the prevalence of renal impairments in PA patients and identified parameters that increase the risk for them. Design This is a retrospective cross-sectional study. We assessed the PA database established by the multicenter Japan PA study (JPAS). Data were also collected from patients with essential hypertension (EHT). Methods We compared the prevalences of proteinuria and lowered estimated glomerular filtration rate (eGFR) between patients with PA and age, sex, blood pressure and duration of hypertension-matched patients with EHT. We also performed logistic regression analysis to identify parameters that increase the risk for these renal impairments. Results Among 2366 PA patients, the prevalences of proteinuria and lowered eGFR were 10.3 and 11.6%, respectively. The prevalence of proteinuria was significantly higher in PA patients than matched-EHT patients (16.8 vs 4.4%), whereas there was no significant difference in the prevalence of lowered eGFR (17.2 vs 15.0%). The logistic regression analysis also showed that the plasma aldosterone concentration (PAC) significantly increases the risk of proteinuria and lowered eGFR, independent of other known risk factors. Conclusion Plasma aldosterone levels are closely associated with renal impairment in patients with PA. This is contrast to our earlier finding that the PAC was not itself linearly associated with cardiovascular events such as stroke or ischemic heart disease. The mechanism underlying the kidney damage in patients with PA may differ from that affecting the cardiovascular system.

Association between plasma aldosterone and markers of tubular and glomerular damage in primary aldosteronism

“…Primary aldosteronism (PA), characterized by autonomous aldosterone production, is a common cause of secondary hypertension, with an estimated prevalence of approximately 10% among hypertensive patients 1‐4 . Previous reports indicate that, due to the effects of excessive aldosterone, renal complications occur more frequently in patients with PA than in patients with essential hypertension (EH) 5,6 …”

“…From a clinical perspective, some studies have demonstrated associations between aldosterone level and glomerular filtration rate decline. For example, Kawashima et al demonstrated that plasma aldosterone levels closely associate with renal impairment in patients with PA 6 . Reincke et al showed that markers of disease activity, such as plasma aldosterone and serum potassium, independently predicted low GFR in untreated PA 11 .…”

“…[1][2][3][4] Previous reports indicate that, due to the effects of excessive aldosterone, renal complications occur more frequently in patients with PA than in patients with essential hypertension (EH). 5,6 In PA, high aldosterone levels increase tubular sodium reabsorption, leading to extracellular volume expansion. 7 These sequences induce glomerular hyperfiltration, which in turn mediates progressive kidney damage after various initiating injuries.…”

“…From a clinical perspective, some studies have demonstrated associations between aldosterone level and glomerular filtration rate decline. For example, Kawashima et al demonstrated that plasma aldosterone levels closely associate with renal impairment in patients with PA. 6 Reincke et al showed that markers of disease activity, such as plasma aldosterone and serum potassium, independently predicted low GFR in untreated PA. 11 However, associations between aldosterone levels and specific biomarkers of kidney damage, including urinary albumin-creatinine ratio (ACR) for glomerular damage, and urinary liver fatty acid-binding protein (L-FABP) for tubular damage, have not been well investigated.…”

Efficacy and safety of esaxerenone (CS-3150), a newly available nonsteroidal mineralocorticoid receptor blocker, in hypertensive patients with primary aldosteronism

“…Compared with patients with essential hypertension, patients with PA have an independent association with higher risks of cerebro-and cardiovascular complications (e.g., stroke, cardiac hypertrophy, atrial fibrillation, coronary artery disease, and cardiac failure), metabolic disturbances, and renal insufficiency [4][5][6][7][8][9].…”