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Multicenter Study
. 2023 Oct;80(10):2187-2195.
doi: 10.1161/HYPERTENSIONAHA.123.21474. Epub 2023 Aug 18.

Primary Aldosteronism in Chronic Kidney Disease: Blood Pressure Control and Kidney and Cardiovascular Outcomes After Surgical Versus Medical Management

Debbie L Cohen  1 , Heather Wachtel  2 , Anand Vaidya  3 , Gregory L Hundemer  4 , Yuta Tezuka  5   6 , Angela Davio  7 , Adina F Turcu  7 , Jordana B Cohen  1   8
Affiliations
Multicenter Study

Primary Aldosteronism in Chronic Kidney Disease: Blood Pressure Control and Kidney and Cardiovascular Outcomes After Surgical Versus Medical Management

Debbie L Cohen et al. Hypertension. 2023 Oct.

Abstract

Background: Diagnosis and treatment of primary aldosteronism (PA) in chronic kidney disease (CKD) may be deferred due to limited evidence supporting safety and efficacy of treatment. Our goal was to assess clinical outcomes in patients with PA and CKD who received surgical or medical management.

Methods: We conducted a multicenter, retrospective cohort study of patients with PA and CKD who underwent adrenal vein sampling from 2009-2019. We characterized clinical outcomes and evaluated differences by surgical versus medical management. Primary outcomes were systolic blood pressure and number of antihypertensive medications. Secondary outcomes were diastolic blood pressure, serum potassium, estimated glomerular filtration rate (eGFR), and kidney and cardiovascular events. Analyses were adjusted for age, sex, race, cardiovascular disease, diabetes, and eGFR.

Results: Of 239 participants with PA and CKD, 158 (66%) underwent adrenalectomy, and 81 (34%) were treated medically. Mean age was 57±10 years, 67% were female, mean eGFR was 45±12 mL/min per 1.73 m2, and 49% were on potassium supplementation. At 5 years, mean blood pressure decreased from 149±22/85±14 to 131±28/78±16 mm Hg and mean number of antihypertensive medications decreased from 4.0±1.5 to 2.4±1.4. Adrenalectomy, compared to medical management, was associated with similar systolic blood pressure (-0.90 mm Hg [95% CI, -6.99 to 5.07]) but fewer medications (1.7 [95% CI, -2.24 to -1.10]), and no difference in potassium levels or kidney or cardiovascular outcomes.

Conclusions: Patients with PA and CKD are likely to benefit from either surgical adrenalectomy or medical management. Detection and treatment of PA may help to reduce blood pressure and medication burden in patients with CKD.

Keywords: adrenalectomy; blood pressure; chronic renal insufficiency; glomerular filtration rate; hyperaldosteronism; potassium.

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Conflict of interest statement

Disclosures D.L. Cohen is supported by the National Institutes of Health (NIH) U24-DK060990 and an American Heart Association Bugher Award. She also reports funding for research and is a consultant for Medtronic and Recor and Data Safety Monitoring Board for Metavention. H. Wachtel is supported by American Surgical Association Foundation Fellowship Research Award, NIH K08-CA270385, UL1-TR001878, and Carole & Otto Haas Award in Clinical Oncology. A. Vaidya reports consulting fees unrelated to the contents of this work from HRA Pharma, Mineralys, Corcept; he is supported by NIH R01-DK115392, R01-HL153004, R01-DK106618, and R01-HL155834. G.L. Hundemer is supported by the Canadian Institutes of Health Research (grant nos. 478459 and 175027), the Kidney Foundation of Canada (grant no. 851937-21KHRG), and the Lorna Jocelyn Wood Chair in Kidney Research. A.F. Turcu is supported by grants 2019087 from the Doris Duke Charitable Foundation and NIH R01-HL15583401. J.B. Cohen supported by NIH R01-HL153646, R01-HL157108, R01-HL155599, R01-HL157264, U01-HL160277, U24-DK060990, and R01-AG074989, and an American Heart Association Bugher Award.

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