Association between acute fall in estimated glomerular filtration rate after treatment for primary aldosteronism and long-term decline in renal function

Hiroki Kobayashi, Masanori Abe, Yoshihiro Nakamura, Katsutoshi Takahashi, Megumi Fujita, Yoshiyu Takeda, Takashi Yoneda, Isao Kurihara, Hiroshi Itoh, Mika Tsuiki, Norio Wada, Takamasa Ichijo, Takuyuki Katabami, Yoshihiro Ogawa, Junji Kawashima, Takanobu Yoshimoto, Masakatsu Sone, Nobuya Inagaki, Minemori Watanabe, Kohei KamemuraYuichi Matsuda, Shoichiro Izawa, Makito Tanabe, Akiyo Tanabe, Tomoko Suzuki, Mitsuhide Naruse

Research output: Contribution to journalArticle

Abstract

Primary aldosteronism causes renal structural damage after glomerular hyperfiltration, and primary aldosteronism-specific treatment leads to an acute fall in estimated glomerular filtration rate (eGFR). We investigated whether this change affected the long-term eGFR slope in a retrospective cohort from the multicenter Japan Primary Aldosteronism Study. We allocated patients with primary aldosteronism to the adrenalectomy (n=202) and MR (mineralocorticoid receptor) antagonist (n=303) groups based on their treatment history and analyzed the association between the initial eGFR fall and long-term eGFR slope. The increased age, low serum potassium levels, high eGFR, and high plasma aldosterone levels were independent predictors for a large initial eGFR fall in both groups. Our analysis of tertiles based on the initial eGFR fall revealed that in the MR antagonist group, patients with a small initial eGFR fall had a significantly steeper long-term eGFR slope than those with a large initial fall (tertile 1 versus 2, P=0.025; tertile 1 versus 3, P=0.017). These associations were not identified in the adrenalectomy group. Thus, the smaller the acute fall in eGFR by initiation of MR antagonists, the greater was the rate of long-term eGFR decline. While the acute fall in eGFR induced by primary aldosteronism-specific treatment is occasionally a clinical concern, our findings highlight the favorable implications of the acute fall with respect to long-term renal outcomes.

Original languageEnglish
Pages (from-to)630-638
Number of pages9
JournalHypertension
Volume74
Issue number3
DOIs
Publication statusPublished - 2019 Sep 1

Fingerprint

Hyperaldosteronism
Glomerular Filtration Rate
Kidney
Mineralocorticoid Receptor Antagonists
Therapeutics
Adrenalectomy
Aldosterone
Potassium
Japan
History

Keywords

  • adrenalectomy
  • aldosterone
  • glomerular filtration rate
  • hyperaldosteronism
  • kidney

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Association between acute fall in estimated glomerular filtration rate after treatment for primary aldosteronism and long-term decline in renal function. / Kobayashi, Hiroki; Abe, Masanori; Nakamura, Yoshihiro; Takahashi, Katsutoshi; Fujita, Megumi; Takeda, Yoshiyu; Yoneda, Takashi; Kurihara, Isao; Itoh, Hiroshi; Tsuiki, Mika; Wada, Norio; Ichijo, Takamasa; Katabami, Takuyuki; Ogawa, Yoshihiro; Kawashima, Junji; Yoshimoto, Takanobu; Sone, Masakatsu; Inagaki, Nobuya; Watanabe, Minemori; Kamemura, Kohei; Matsuda, Yuichi; Izawa, Shoichiro; Tanabe, Makito; Tanabe, Akiyo; Suzuki, Tomoko; Naruse, Mitsuhide.

In: Hypertension, Vol. 74, No. 3, 01.09.2019, p. 630-638.

Research output: Contribution to journalArticle

Kobayashi, H, Abe, M, Nakamura, Y, Takahashi, K, Fujita, M, Takeda, Y, Yoneda, T, Kurihara, I, Itoh, H, Tsuiki, M, Wada, N, Ichijo, T, Katabami, T, Ogawa, Y, Kawashima, J, Yoshimoto, T, Sone, M, Inagaki, N, Watanabe, M, Kamemura, K, Matsuda, Y, Izawa, S, Tanabe, M, Tanabe, A, Suzuki, T & Naruse, M 2019, 'Association between acute fall in estimated glomerular filtration rate after treatment for primary aldosteronism and long-term decline in renal function', Hypertension, vol. 74, no. 3, pp. 630-638. https://doi.org/10.1161/HYPERTENSIONAHA.119.13131
Kobayashi, Hiroki ; Abe, Masanori ; Nakamura, Yoshihiro ; Takahashi, Katsutoshi ; Fujita, Megumi ; Takeda, Yoshiyu ; Yoneda, Takashi ; Kurihara, Isao ; Itoh, Hiroshi ; Tsuiki, Mika ; Wada, Norio ; Ichijo, Takamasa ; Katabami, Takuyuki ; Ogawa, Yoshihiro ; Kawashima, Junji ; Yoshimoto, Takanobu ; Sone, Masakatsu ; Inagaki, Nobuya ; Watanabe, Minemori ; Kamemura, Kohei ; Matsuda, Yuichi ; Izawa, Shoichiro ; Tanabe, Makito ; Tanabe, Akiyo ; Suzuki, Tomoko ; Naruse, Mitsuhide. / Association between acute fall in estimated glomerular filtration rate after treatment for primary aldosteronism and long-term decline in renal function. In: Hypertension. 2019 ; Vol. 74, No. 3. pp. 630-638.
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AU - Abe, Masanori

AU - Nakamura, Yoshihiro

AU - Takahashi, Katsutoshi

AU - Fujita, Megumi

AU - Takeda, Yoshiyu

AU - Yoneda, Takashi

AU - Kurihara, Isao

AU - Itoh, Hiroshi

AU - Tsuiki, Mika

AU - Wada, Norio

AU - Ichijo, Takamasa

AU - Katabami, Takuyuki

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AU - Kawashima, Junji

AU - Yoshimoto, Takanobu

AU - Sone, Masakatsu

AU - Inagaki, Nobuya

AU - Watanabe, Minemori

AU - Kamemura, Kohei

AU - Matsuda, Yuichi

AU - Izawa, Shoichiro

AU - Tanabe, Makito

AU - Tanabe, Akiyo

AU - Suzuki, Tomoko

AU - Naruse, Mitsuhide

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