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Multicenter Study
. 2024 Oct 1;42(10):1805-1812.
doi: 10.1097/HJH.0000000000003813. Epub 2024 Jul 5.

Impact of primary aldosteronism on kidney function: results from the SPAIN-ALDO registry

Marta Araujo-Castro  1   2 , Miguel Paja Fano  3   4 , Marga González-Boillos  5 , Eider Pascual-Corrales  1 , Patricia Martín Rojas-Marcos  6 , Ana García-Cano  7 , Jorge Gabriel Ruiz-Sanchez  8 , Almudena Vicente  9 , Emilia Gómez-Hoyos  10 , Anna Casterás  11 , Albert Puig-Pérez  11 , Iñigo García Sanz  12 , Mónica Recasens  13 , Rebeca Barahona San Millan  13 , María José Picón César  14   15 , Patricia Díaz Guardiola  16 , Carolina M Perdomo  17 , Laura Manjón-Miguélez  18   19 , Angel Rebollo Román  20 , Cristina Robles Lázaro  21 , José María Recio  21 , Manuel Morales-Ruiz  22 , María Calatayud  23 , Noemi Jiménez López  23 , Diego Meneses  6 , Miguel Sampedro Nuñez  24 , Elena Mena Ribas  25 , Alicia Sanmartín Sánchez  21 , Cesar Gonzalvo Diaz  26 , Cristina Lamas  26 , María Del Castillo Tous  27 , Joaquín Serrano  28 , Theodora Michalopoulou  29 , Susana Tenés Rodrigo  30 , Ricardo Roa Chamorro  31 , Fernando Jaén Aguila  31 , Eva María Moya Mateo  32 , Sonsoles Gutiérrez-Medina  17 , Felicia Alexandra Hanzu  33 , Paola Parra Ramírez  6
Affiliations
Multicenter Study

Impact of primary aldosteronism on kidney function: results from the SPAIN-ALDO registry

Marta Araujo-Castro et al. J Hypertens. .

Abstract

Aim: 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.

Methods: 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).

Results: 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).

Conclusion: 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.

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