Osman Wessam, Al Dohani Hayam, Al Hinai Al Shaima, Hannawi Suad, M Shaheen Faissal A, Al Salmi Issa
Department of Internal Medicine, The Royal Hospital, Muscat, Oman.
Department of Medicine, Ministry of Health and Prevention, Dubai, United Arab Emirates.
Saudi J Kidney Dis Transpl. 2020 Jan-Feb;31(1):70-78. doi: 10.4103/1319-2442.279963.
As a component of the metabolic syndrome, hypertension (HTN) is increasing throughout the world with variable percentages, but mostly among developing world. Aldosterone plays a role in the relationship between aldosterone and nephropathy. We aimed to evaluate the relationship between aldosterone renin ratio (ARR) and chronic kidney disease (CKD). Variables drawn from the computerized hospital information database were all patients who had an ARR above 35 (if aldosterone reading was above 300 pmol/L). A total of 1584 patients, of whom 777 were male and 807 were female, with a mean [standard deviation (SD)] of 43.3 (16.5) years were studied. The mean ARR was 210.1 (SD: 246.4) in males and 214.3 and 210.1 in females, P = 0.51. The mean estimated glomerular filtration rate (eGFR) was 50.2 (SD 12.6); in males, it was 49.99 (0.90) and in females, it was 50.48 (0.92), P = 0.70. The regression model revealed a negative relationship between ARR and GFR with a coefficient of -2.08, 95% confidence interval: -4.6, 0.21, P = 0.07. CKD population with HTN tends to have a very high level of ARR, and those with advanced CKD have higher ARR. However, high ARR could have low eGFR and kidney dysfunction on follow-up. In view of high prevalence of noncommunicable disease and high early CKD population, there is an important need to consider comprehensive management strategies that involve the blockage of high renin-angiotensin-aldosterone and the use of mineralocorticosteroid receptor blockers.
作为代谢综合征的一个组成部分，高血压在全球范围内的发病率正以不同的百分比上升，但在发展中世界更为普遍。醛固酮在醛固酮与肾病的关系中起作用。我们旨在评估醛固酮肾素比值（ARR）与慢性肾脏病（CKD）之间的关系。从计算机化医院信息数据库中提取的变量为所有ARR高于35（如果醛固酮读数高于300 pmol/L）的患者。共研究了1584例患者，其中男性777例，女性807例，平均[标准差（SD）]年龄为43.3（16.5）岁。男性的平均ARR为210.1（SD：246.4），女性为214.3和210.1，P = 0.51。平均估计肾小球滤过率（eGFR）为50.2（SD 12.6）；男性为49.99（0.90），女性为50.48（0.92），P = 0.70。回归模型显示ARR与GFR之间呈负相关，系数为-2.08，95%置信区间：-4.6，0.21，P = 0.07。患有高血压的CKD人群往往ARR水平非常高，而患有晚期CKD的人群ARR更高。然而，高ARR在随访中可能伴有低eGFR和肾功能障碍。鉴于非传染性疾病的高患病率和CKD早期人群数量众多，迫切需要考虑综合管理策略，包括阻断高肾素-血管紧张素-醛固酮系统以及使用盐皮质激素受体阻滞剂。
