Association of Kidney Function With Residual Hypertension After Treatment of Aldosterone-Producing Adenoma
Received 3 December 2008; accepted 2 June 2009. published online 24 July 2009.
Refers to article:
The Dual Role of the Kidney in Primary Aldosteronism: Key Determinant in Rescue From Volume Expansion and Persistence of Hypertension
Leonardo A. Sechi, Cristiana Catena
American Journal of Kidney Diseases
October 2009 (Vol. 54, Issue 4, Pages 594-597) Full Text |
Full-Text PDF (134 KB)
Background
Autonomous secretion of aldosterone in patients with primary aldosteronism increases glomerular filtration rate and causes kidney damage. The influence of a mild decrease in kidney function on residual hypertension after adrenalectomy is unexplored.
Study Design
Nonconcurrent prospective study.
Setting & Participants
The study was based on the Taiwan Primary Aldosteronism Investigation (TAIPAI) database. 150 patients (61 men; overall mean age, 47.2 ± 11.6 years) with a diagnosis of aldosterone-producing adenoma had undergone unilateral adrenalectomy at National Taiwan University Hospital from July 1999 to January 2007.
Residual hypertension after adrenalectomy, defined either as less than 75% of recorded blood pressure measurements with systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 90 mm Hg or requiring antihypertensive medications during the first year after surgery.
Results
Before surgery, 27 (18%), 72 (48%), and 51 (34%) patients had moderately to severely decreased (<60 mL/min/1.73 m2), mildly decreased (60 ≤ eGFR < 90 mL/min/1.73 m2), or nondecreased eGFR (≥90 mL/min/1.73 m2), respectively. After surgery, 16 (59.3%), 29 (40.3%), and 10 (19.3%) patients in each category had postsurgery residual hypertension. Compared with patients without decreased eGFR before surgery, adjusted odds ratios for postsurgery residual hypertension were 2.7 (95% confidence interval, 1.03 to 7.0; P = 0.04) and 2.8 (95% confidence interval, 1.05 to 9.3) for mildly and moderately to severely decreased eGFR, respectively.
Limitations
Arbitrary definition for residual hypertension.
Conclusions
Two-thirds of patients with aldosterone-producing adenoma were cured of hypertension by means of unilateral adrenalectomy. Kidney function impairment, even mild, appears to be associated with a high incidence of postsurgery residual hypertension.
1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
2Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
3Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, OH
4Department of Medical Image, National Taiwan University Hospital, Taipei, Taiwan
5Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
6Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
Address correspondence to Kwan-Dun Wu, MD, PhD, Rm 1419, Clinical Research Bldg, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei 100, Taiwan
ABSTRACT