Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism (Endocrinol Metab 2021;36:875-84, Ye Seul Yang et al.)

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Endocrinol Metab. 2022;37(6):951-952
Publication date (electronic) : 2022 November 25
doi : https://doi.org/10.3803/EnM.2022.1606
1Department of Anesthesiology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
2Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
Corresponding author: Liang Zhou. Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, China Tel: +86-189-8060-1848, Fax: +86-28-8542-3466 E-mail: zhouliang5678@foxmail.com
*

These authors contributed equally to this work.

Received 2022 October 2; Accepted 2022 October 11.

Primary aldosteronism (PA) is characterized by the overproduction of aldosterone, which is independent of the renin-angiotensin-aldosterone system. PA has been shown to be more prevalent among the elderly. Prolonged exposure to excessive aldosterone and mineralocorticoid receptor overactivation leads to renal vascular remodeling and structural damage, posing a high risk of chronic kidney disease (CKD). PA has also demonstrated correlations with cardiovascular events and metabolic syndrome, greatly impacting the prognosis and quality of life in the elderly population, and even increasing the risk of death.

The 2020 European Society of Hypertension Consensus has indicated that adrenalectomy, which relieves aldosterone overexposure, is the preferred treatment for unilateral PA. However, the elderly population is characterized by complicated primary diseases and is susceptible to postoperative complications. Consequently, multiple evaluations are required to determine the risks and benefits of adrenalectomy in the elderly. This leads to a question: in comparison with non-elderly patients, what are the differences in postoperative renal outcomes in the old? With great interest, we read Yang’s article published in Endocrinology and Metabolism, which found that age was associated with postoperative CKD in PA patients (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.00 to 1.08) [1].

To further investigate the relationship between age and postoperative CKD in PA patients, we conducted a meta-analysis of six studies including 629 participants (Supplemental Fig. S1) [1-6]. Similar to Yang’s study, we also found a positive association between age and postoperative CKD (OR, 1.05; 95% CI, 1.02 to 1.09; P=0.001; I2==13.6%). Five of the included studies defined postoperative CKD as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, while one defined it as <45 mL/min/1.73 m2. To avoid heterogeneity in the results due to different definitions, we further performed a subgroup analysis by CKD definition and found that the positive association between age and postoperative CKD remained significant in the subgroup of eGFR <60 mL/min/1.73 m2 (OR, 1.05; 95% CI, 1.02 to 1.09; P<0.001; I2==22.1%).

Notably, in the subgroup with an eGFR <60 mL/min/1.73 m2, the mean age was 49.1±10 years, while in the subgroup with an eGFR <45 mL/min/1.73 m2, the population was older than 65 years. An eGFR below 60 mL/min/1.73 m2 indicates that an individual has lost at least 50% of his or her renal function compared to a healthy status, and this cutoff is often used to determine CKD. However, in the elderly, eGFR decreases physiologically with age, and the above threshold may overestimate the CKD burden. Therefore, it seems reasonable to regard an eGFR <45 mL/min/1.73 m2 as an observable indicator of CKD in the elderly population. However, in 2021, Liu et al. [7] conducted a cohort study including 127,132 people, and found that elderly patients (>65 years) with an eGFR <60 mL/min/1.73 m2 had a higher risk of renal failure and death. Therefore, we wonder whether an eGFR <60 mL/min/1.73 m2 might be more appropriate as the observed outcome.

Research on the correlation between age and postoperative CKD in PA patients holds great potential. High-quality research is needed to further validate the association between various age groups and different stages of postoperative CKD in PA patients.

Supplementary Material

Supplemental Fig. S1.

Forest plot of the correlation between age and postoperative chronic kidney disease. OR, odds ratio; CI, confidence interval.

enm-2022-1606-suppl1.pdf

Notes

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

References

1. Yang YS, Lee SH, Kim JH, Yoo JH, Lee JH, Lee SY, et al. Contralateral suppression at adrenal venous sampling is associated with renal impairment following adrenalectomy for unilateral primary aldosteronism. Endocrinol Metab (Seoul) 2021;36:875–84.
2. Kim DH, Kwon HJ, Ji SA, Jang HR, Jung SH, Kim JH, et al. Risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism. Medicine (Baltimore) 2016;95e3930.
3. Kim IY, Park IS, Kim MJ, Han M, Rhee H, Seong EY, et al. Change in kidney function after unilateral adrenalectomy in patients with primary aldosteronism: identification of risk factors for decreased kidney function. Int Urol Nephrol 2018;50:1887–95.
4. Utsumi T, Kawamura K, Imamoto T, Nagano H, Tanaka T, Kamiya N, et al. Preoperative masked renal damage in Japanese patients with primary aldosteronism: identification of predictors for chronic kidney disease manifested after adrenalectomy. Int J Urol 2013;20:685–91.
5. Ren X, Shang J, Ren R, Ma D. Analysis of the influencing factors for postoperative chronic kidney insufficiency in patients with primary aldosteronism. Chin J Urol 2020;41:731–5.
6. Takeda M, Yamamoto K, Akasaka H, Rakugi H, Naruse M, Takeda Y, et al. Clinical characteristics and postoperative outcomes of primary aldosteronism in the elderly. J Clin Endocrinol Metab 2018;103:3620–9.
7. Liu P, Quinn RR, Lam NN, Elliott MJ, Xu Y, James MT, et al. Accounting for age in the definition of chronic kidney disease. JAMA Intern Med 2021;181:1359–66.

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