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Risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism

Primary aldosteronism (PA) may induce significant decline of renal function and structural damage of kidney. However, it is difficult to evaluate accurate renal function in patients with PA, because glomerular hyperfiltration and aldosterone escape can conceal renal impairment. In this retrospective...

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Autores principales: Kim, Do Hee, Kwon, Hee Jin, Ji, Sang A., Jang, Hye Ryoun, Jung, Sin-Ho, Kim, Jung-Han, Kim, Jae Hyeon, Lee, Jung Eun, Huh, Wooseong, Kim, Yoon-Goo, Kim, Dae Joong, Oh, Ha Young
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058795/
https://www.ncbi.nlm.nih.gov/pubmed/27399066
http://dx.doi.org/10.1097/MD.0000000000003930
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author Kim, Do Hee
Kwon, Hee Jin
Ji, Sang A.
Jang, Hye Ryoun
Jung, Sin-Ho
Kim, Jung-Han
Kim, Jae Hyeon
Lee, Jung Eun
Huh, Wooseong
Kim, Yoon-Goo
Kim, Dae Joong
Oh, Ha Young
author_facet Kim, Do Hee
Kwon, Hee Jin
Ji, Sang A.
Jang, Hye Ryoun
Jung, Sin-Ho
Kim, Jung-Han
Kim, Jae Hyeon
Lee, Jung Eun
Huh, Wooseong
Kim, Yoon-Goo
Kim, Dae Joong
Oh, Ha Young
author_sort Kim, Do Hee
collection PubMed
description Primary aldosteronism (PA) may induce significant decline of renal function and structural damage of kidney. However, it is difficult to evaluate accurate renal function in patients with PA, because glomerular hyperfiltration and aldosterone escape can conceal renal impairment. In this retrospective cohort study, we compared changes in renal function after unilateral adrenalectomy between patients with PA and patients with other adrenal diseases. Risk factors associated with postoperative renal impairment in patients with PA were analyzed. A total of 558 patients who received unilateral adrenalectomy between January 2002 and June 2013 were included: 136 patients with PA and 422 patients with other adrenal diseases (control). Postoperative serial changes in estimated glomerular filtration rate (eGFR) were analyzed in both groups. Multivariate analyses were performed to identify risk factors of renal impairment after adrenalectomy in all patients and the PA group. Postoperative renal impairment was defined as postoperative eGFR decline of >25% from preoperative eGFR. Chronic kidney disease (CKD) was defined as an eGFR <60 mL/min/1.73 m(2). There were no differences in preoperative eGFR between groups. The PA group showed a significant decrease in eGFR 3 days, 2 weeks, and 6 months after surgery compared to the control group. The PA group showed significant improvement of hypertension after surgery. In the PA group, 53 (39.0%) patients showed postoperative renal impairment. Multivariate regression analysis identified long-standing hypertension, low body mass index, low serum potassium, and high preoperative eGFR as risk factors for postoperative renal impairment. Among the 89 patients with preoperative eGFR ≥60 mL/min/1.73 m(2), 29 (32.6%) patients developed CKD postoperatively. Age, low serum potassium, low preoperative eGFR, and high serum cholesterol or uric acid were associated with the postoperative CKD development. Our study demonstrates that patients with PA with old age, low serum potassium, long-standing hypertension, and high serum uric acid or cholesterol are at risk of renal impairment after surgical treatment. High preoperative eGFR was also a risk factor for postoperative renal impairment, whereas low preoperative eGFR was a risk factor for postoperative CKD. Close monitoring of renal function and adequate management are required for patients with these risk factors.
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spelling pubmed-50587952016-11-18 Risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism Kim, Do Hee Kwon, Hee Jin Ji, Sang A. Jang, Hye Ryoun Jung, Sin-Ho Kim, Jung-Han Kim, Jae Hyeon Lee, Jung Eun Huh, Wooseong Kim, Yoon-Goo Kim, Dae Joong Oh, Ha Young Medicine (Baltimore) 5200 Primary aldosteronism (PA) may induce significant decline of renal function and structural damage of kidney. However, it is difficult to evaluate accurate renal function in patients with PA, because glomerular hyperfiltration and aldosterone escape can conceal renal impairment. In this retrospective cohort study, we compared changes in renal function after unilateral adrenalectomy between patients with PA and patients with other adrenal diseases. Risk factors associated with postoperative renal impairment in patients with PA were analyzed. A total of 558 patients who received unilateral adrenalectomy between January 2002 and June 2013 were included: 136 patients with PA and 422 patients with other adrenal diseases (control). Postoperative serial changes in estimated glomerular filtration rate (eGFR) were analyzed in both groups. Multivariate analyses were performed to identify risk factors of renal impairment after adrenalectomy in all patients and the PA group. Postoperative renal impairment was defined as postoperative eGFR decline of >25% from preoperative eGFR. Chronic kidney disease (CKD) was defined as an eGFR <60 mL/min/1.73 m(2). There were no differences in preoperative eGFR between groups. The PA group showed a significant decrease in eGFR 3 days, 2 weeks, and 6 months after surgery compared to the control group. The PA group showed significant improvement of hypertension after surgery. In the PA group, 53 (39.0%) patients showed postoperative renal impairment. Multivariate regression analysis identified long-standing hypertension, low body mass index, low serum potassium, and high preoperative eGFR as risk factors for postoperative renal impairment. Among the 89 patients with preoperative eGFR ≥60 mL/min/1.73 m(2), 29 (32.6%) patients developed CKD postoperatively. Age, low serum potassium, low preoperative eGFR, and high serum cholesterol or uric acid were associated with the postoperative CKD development. Our study demonstrates that patients with PA with old age, low serum potassium, long-standing hypertension, and high serum uric acid or cholesterol are at risk of renal impairment after surgical treatment. High preoperative eGFR was also a risk factor for postoperative renal impairment, whereas low preoperative eGFR was a risk factor for postoperative CKD. Close monitoring of renal function and adequate management are required for patients with these risk factors. Wolters Kluwer Health 2016-07-08 /pmc/articles/PMC5058795/ /pubmed/27399066 http://dx.doi.org/10.1097/MD.0000000000003930 Text en Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 5200
Kim, Do Hee
Kwon, Hee Jin
Ji, Sang A.
Jang, Hye Ryoun
Jung, Sin-Ho
Kim, Jung-Han
Kim, Jae Hyeon
Lee, Jung Eun
Huh, Wooseong
Kim, Yoon-Goo
Kim, Dae Joong
Oh, Ha Young
Risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism
title Risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism
title_full Risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism
title_fullStr Risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism
title_full_unstemmed Risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism
title_short Risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism
title_sort risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism
topic 5200
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058795/
https://www.ncbi.nlm.nih.gov/pubmed/27399066
http://dx.doi.org/10.1097/MD.0000000000003930
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