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Association Between Acute Fall in Estimated Glomerular Filtration Rate After Treatment for Primary Aldosteronism and Long-Term Decline in Renal Function.

From the Division of Nephrology, Hypertension, and Endocrinology, Nihon University School of Medicine, Tokyo, Japan (H.K., M.A., Y.N.). Section on Genetics and Epidemiology, Research Division, Joslin Diabetes Center, Boston, MA (H.K.). Department of Medicine, Harvard Medical School, Boston, MA (H.K.). Division of Metabolism, Showa General Hospital, Tokyo, Japan (K.T.). Division of Nephrology and Endocrinology, University of Tokyo, Japan (K.T., M.F.). Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Japan (Y.T., T.Y.). Department of Endocrinology, Metabolism, and Nephrology, Keio University School of Medicine, Tokyo, Japan (I.K., H.I.). Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan (M.T., M.N.). Department of Diabetes and Endocrinology, Sapporo City General Hospital, Japan (N.W.). Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital, Japan (T.I.). Division of Metabolism and Endocrinology, Department of Internal Medicine, St Marianna University School of Medicine, Yokohama City Seibu Hospital, Japan (T.K.). Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Japan (Y.O., T.Y.). Department of Metabolic Medicine, Faculty of Life Science, Kumamoto University, Japan (J.K.). Department of Diabetes, Endocrinology, and Nutrition, Kyoto University, Japan (M.S., N.I.). Department of Endocrinology and Diabetes, Okazaki City Hospital, Japan (M.W.). Department of Cardiology, Akashi Medical Center, Japan (K.K.). Department of Cardiology, Sanda City Hospital, Japan (Y.M.). Department of Endocrinology and Metabolism, Tottori University Hospital, Yonago, Japan (S.I.). Department of Endocrinology and Diabetes Mellitus, Fukuoka University Hospital, Japan (M.T.). Division of Endocrinology, National Center for Global Health and Medicine, Tokyo, Japan (A.T.). Department of Public Health, International University of Health and Welfare School of Medicine, Chiba, Japan (T.S.).

Hypertension (Dallas, Tex. : 1979). 2019;(3):630-638
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Abstract

Primary aldosteronism causes renal structural damage after glomerular hyperfiltration, and primary aldosteronism-specific treatment leads to an acute fall in estimated glomerular filtration rate (eGFR). We investigated whether this change affected the long-term eGFR slope in a retrospective cohort from the multicenter Japan Primary Aldosteronism Study. We allocated patients with primary aldosteronism to the adrenalectomy (n=202) and MR (mineralocorticoid receptor) antagonist (n=303) groups based on their treatment history and analyzed the association between the initial eGFR fall and long-term eGFR slope. The increased age, low serum potassium levels, high eGFR, and high plasma aldosterone levels were independent predictors for a large initial eGFR fall in both groups. Our analysis of tertiles based on the initial eGFR fall revealed that in the MR antagonist group, patients with a small initial eGFR fall had a significantly steeper long-term eGFR slope than those with a large initial fall (tertile 1 versus 2, P=0.025; tertile 1 versus 3, P=0.017). These associations were not identified in the adrenalectomy group. Thus, the smaller the acute fall in eGFR by initiation of MR antagonists, the greater was the rate of long-term eGFR decline. While the acute fall in eGFR induced by primary aldosteronism-specific treatment is occasionally a clinical concern, our findings highlight the favorable implications of the acute fall with respect to long-term renal outcomes.

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