Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal Madrid.
Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid.
J Hypertens. 2024 Oct 1;42(10):1805-1812. doi: 10.1097/HJH.0000000000003813. Epub 2024 Jul 5.
To evaluate the impact of aldosterone excess on renal function in individuals with primary aldosteronism and to compare its evolution after surgery or mineralocorticoid receptor antagonist (MRA) treatment.
A multicentre, retrospective cohort study of primary aldosteronism patients in follow-up in 36 Spanish tertiary hospitals, who underwent specific treatment for primary aldosteronism (MRA or adrenalectomy).
A total of 789 patients with primary aldosteronism were included, with a median age of 57.5 years and 41.8% being women. At primary aldosteronism diagnosis, the prevalence of chronic kidney disease (CKD) was 10.7% ( n = 84), with 75% of cases classified as state 3a ( n = 63). Primary aldosteronism patients with CKD had a longer duration of hypertension, a higher prevalence of type 2 diabetes, dyslipidaemia, cardiovascular events, hypokalaemia, and albuminuria. Unilateral adrenalectomy was performed in 41.8% of cases ( n = 330), and 459 patients were treated with MRA. After a median follow-up of 30.7 months (range 13.3-68.4), there was a significant decline in the estimated glomerular filtration rate (eGFR) in operated patients and those receiving MRA. During follow-up, 24.4% of patients with CKD at the time of primary aldosteronism diagnosis had normalized renal function, and 39% of those with albuminuria had albuminuria remission. There were no differences in renal function or albuminuria regression between the two therapy groups. However, development of albuminuria was less common in operated than in medically treated patients (0 vs. 6.0%, P = 0.009).
CKD affects around 10% of the patients with primary aldosteronism, with a higher risk in individuals with long-term hypertension, type 2 diabetes, dyslipidaemia, cardiovascular events, hypokalaemia, and albuminuria. At short-term, both MRA and surgical treatment lead to a reduction of renal function, but adrenalectomy led to higher renal protection.
评估原发性醛固酮增多症患者醛固酮过多对肾功能的影响，并比较手术或盐皮质激素受体拮抗剂 (MRA) 治疗后的变化。
这是一项多中心、回顾性队列研究，纳入了在西班牙 36 家三级医院接受原发性醛固酮增多症随访的患者，这些患者接受了特定的原发性醛固酮增多症治疗（MRA 或肾上腺切除术）。
共纳入 789 例原发性醛固酮增多症患者，中位年龄为 57.5 岁，41.8%为女性。在原发性醛固酮增多症诊断时，慢性肾脏病（CKD）的患病率为 10.7%（n=84），其中 75%的病例为 3a 期（n=63）。有 CKD 的原发性醛固酮增多症患者高血压病程更长，2 型糖尿病、血脂异常、心血管事件、低钾血症和蛋白尿的患病率更高。单侧肾上腺切除术在 41.8%的病例中进行（n=330），459 例患者接受 MRA 治疗。中位随访 30.7 个月（范围 13.3-68.4）后，手术和 MRA 治疗患者的估算肾小球滤过率（eGFR）均显著下降。在随访期间，原发性醛固酮增多症诊断时患有 CKD 的患者中有 24.4%的患者肾功能正常，蛋白尿患者中有 39%的患者蛋白尿缓解。两组治疗之间肾功能或蛋白尿缓解无差异。然而，与接受药物治疗的患者相比，手术治疗患者的蛋白尿发生较少（0 比 6.0%，P=0.009）。
CKD 影响约 10%的原发性醛固酮增多症患者，高血压病程较长、2 型糖尿病、血脂异常、心血管事件、低钾血症和蛋白尿的患者风险更高。短期来看，MRA 和手术治疗均导致肾功能下降，但肾上腺切除术对肾脏的保护作用更高。
