Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Shanghai, China.
Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Endocrinol (Lausanne). 2024 Nov 7;15:1467742. doi: 10.3389/fendo.2024.1467742. eCollection 2024.
Patients with primary aldosteronism present with renal function decline after unilateral adrenalectomies. Our study aimed to assess the evolution of renal function after adrenalectomy in patients with primary aldosteronism across different age groups and to identify risk factors for postoperative renal function deterioration.
We included 210 patients with primary aldosteronism categorized into three age groups: <40, 40-60, and ≥60 years old. We followed up the patients for 1 month, 1 year, and 5 years after adrenalectomy to assess outcomes. Multivariate analyses were performed to identify predictors of renal function deterioration, and a univariate logistic regression analysis was used to assess the relationship between mutation status and the decline in renal function.
Patients aged <40 years had a shorter duration of hypertension, higher preoperative diastolic blood pressure, and higher preoperative estimated glomerular filtration rate (eGFR) than did those in the other age groups. This group also exhibited the highest rate of complete clinical success, although there were no significant differences in complete biochemical success among age groups. Renal function declined in all three groups after adrenalectomy. However, changes in blood pressure and eGFR in the short- or long-term after adrenalectomy showed no significant differences among the three groups. Hypertension duration, preoperative systolic blood pressure (SBP), and plasma aldosterone concentration (PAC) were predictors of postoperative renal function deterioration. wild-type status was significantly correlated with the occurrence of chronic kidney disease after adrenalectomy.
Unilateral adrenalectomy demonstrates favorable biochemical and clinical outcomes in patients with primary aldosteronism, irrespective of age. Long-term eGFR decline is similar among the different age groups. mutation exhibits a protective effect against the risk of chronic kidney disease after unilateral adrenalectomy.
醛固酮增多症患者行单侧肾上腺切除术（肾上腺切除术）后肾功能会下降。本研究旨在评估不同年龄组醛固酮增多症患者肾上腺切除术后肾功能的变化，并确定术后肾功能恶化的危险因素。
我们纳入了 210 例醛固酮增多症患者，分为<40 岁、40-60 岁和≥60 岁三个年龄组。术后 1 个月、1 年和 5 年对患者进行随访，评估结局。进行多变量分析以确定肾功能恶化的预测因素，并进行单变量逻辑回归分析以评估突变状态与肾功能下降之间的关系。
<40 岁的患者高血压病程较短，术前舒张压较高，估算肾小球滤过率（eGFR）较高。该组的完全临床成功率最高，尽管各组间完全生化成功率无显著差异。三组患者肾上腺切除术后肾功能均下降。然而，肾上腺切除术后短期或长期血压和 eGFR 的变化在三组之间无显著差异。高血压病程、术前收缩压（SBP）和血浆醛固酮浓度（PAC）是术后肾功能恶化的预测因素。野生型状态与肾上腺切除术后慢性肾脏病的发生显著相关。
单侧肾上腺切除术对醛固酮增多症患者具有良好的生化和临床结局，与年龄无关。不同年龄组间 eGFR 的长期下降相似。突变状态对单侧肾上腺切除术后慢性肾脏病的风险具有保护作用。
