原发性醛固酮增多症对肾功能的影响：SPAIN-ALDO 登记的结果。

IF 3.3 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Hypertension Pub Date : 2024-10-01 Epub Date: 2024-07-05 DOI:10.1097/HJH.0000000000003813

Marta Araujo-Castro, Miguel Paja Fano, Marga González-Boillos, Eider Pascual-Corrales, Patricia Martín Rojas-Marcos, Ana García-Cano, Jorge Gabriel Ruiz-Sanchez, Almudena Vicente, Emilia Gómez-Hoyos, Anna Casterás, Albert Puig-Pérez, Iñigo García Sanz, Mónica Recasens, Rebeca Barahona San Millan, María José Picón César, Patricia Díaz Guardiola, Carolina M Perdomo, Laura Manjón-Miguélez, Angel Rebollo Román, Cristina Robles Lázaro, José María Recio, Manuel Morales-Ruiz, María Calatayud, Noemi Jiménez López, Diego Meneses, Miguel Sampedro Nuñez, Elena Mena Ribas, Alicia Sanmartín Sánchez, Cesar Gonzalvo Diaz, Cristina Lamas, María Del Castillo Tous, Joaquín Serrano, Theodora Michalopoulou, Susana Tenés Rodrigo, Ricardo Roa Chamorro, Fernando Jaén Aguila, Eva María Moya Mateo, Sonsoles Gutiérrez-Medina, Felicia Alexandra Hanzu, Paola Parra Ramírez

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引用次数: 0

摘要

目的：评估醛固酮过多对原发性醛固酮增多症患者肾功能的影响，并比较手术或矿物皮质激素受体拮抗剂（MRA）治疗后肾功能的变化：方法：对西班牙 36 家三级医院随访的原发性醛固酮增多症患者进行多中心、回顾性队列研究，这些患者接受了原发性醛固酮增多症的特定治疗（MRA 或肾上腺切除术）：共纳入 789 名原发性醛固酮增多症患者，中位年龄为 57.5 岁，41.8% 为女性。在确诊原发性醛固酮增多症时，慢性肾脏病（CKD）的发病率为 10.7%（84 例），75% 的病例被归类为 3a 状态（63 例）。患有慢性肾脏病的原发性醛固酮增多症患者的高血压持续时间更长，2型糖尿病、血脂异常、心血管事件、低钾血症和白蛋白尿的发病率更高。41.8%的病例（n = 330）进行了单侧肾上腺切除术，459名患者接受了MRA治疗。中位随访 30.7 个月（13.3-68.4 个月）后，手术患者和接受 MRA 治疗的患者的估计肾小球滤过率（eGFR）显著下降。在随访期间，原发性醛固酮增多症确诊时患有慢性肾脏病的患者中有 24.4% 的肾功能恢复正常，有白蛋白尿的患者中有 39% 的白蛋白尿缓解。两个治疗组在肾功能或白蛋白尿缓解方面没有差异。然而，手术治疗患者出现白蛋白尿的比例低于药物治疗患者（0 比 6.0%，P = 0.009）：结论：原发性醛固酮增多症患者中约有 10%患有慢性肾脏病，长期高血压、2 型糖尿病、血脂异常、心血管事件、低钾血症和白蛋白尿患者的风险更高。在短期内，MRA 和手术治疗都会导致肾功能减退，但肾上腺切除术对肾脏的保护作用更大。

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

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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来源期刊

Journal of Hypertension 医学-外周血管病

CiteScore

7.90

自引率

6.10%

发文量

1389

审稿时长

3 months

期刊介绍： The Journal of Hypertension publishes papers reporting original clinical and experimental research which are of a high standard and which contribute to the advancement of knowledge in the field of hypertension. The Journal publishes full papers, reviews or editorials (normally by invitation), and correspondence.