Chronological outcomes of renal function after adrenalectomy in patients with primary aldosteronism across age groups

Yu Ma; Xiaofeng Tang; Qian Ge; Jianzhong Xu; Pingjin Gao; Jiguang Wang; Limin Zhu

doi:10.3389/fendo.2024.1467742

Chronological outcomes of renal function after adrenalectomy in patients with primary aldosteronism across age groups

Front Endocrinol (Lausanne). 2024 Nov 7:15:1467742. doi: 10.3389/fendo.2024.1467742. eCollection 2024.

Authors

Yu Ma^{1

2}, Xiaofeng Tang^{1

2}, Qian Ge^{1

2}, Jianzhong Xu^{1

2}, Pingjin Gao^{1

2}, Jiguang Wang^{1

2}, Limin Zhu^{1

2}

Affiliations

¹ Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Shanghai, China.
² Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract

Background: Patients with primary aldosteronism present with renal function decline after unilateral adrenalectomies. Our study aimed to assess the evolution of renal function after adrenalectomy in patients with primary aldosteronism across different age groups and to identify risk factors for postoperative renal function deterioration.

Methods: We included 210 patients with primary aldosteronism categorized into three age groups: <40, 40-60, and ≥60 years old. We followed up the patients for 1 month, 1 year, and 5 years after adrenalectomy to assess outcomes. Multivariate analyses were performed to identify predictors of renal function deterioration, and a univariate logistic regression analysis was used to assess the relationship between KCNJ5 mutation status and the decline in renal function.

Results: Patients aged <40 years had a shorter duration of hypertension, higher preoperative diastolic blood pressure, and higher preoperative estimated glomerular filtration rate (eGFR) than did those in the other age groups. This group also exhibited the highest rate of complete clinical success, although there were no significant differences in complete biochemical success among age groups. Renal function declined in all three groups after adrenalectomy. However, changes in blood pressure and eGFR in the short- or long-term after adrenalectomy showed no significant differences among the three groups. Hypertension duration, preoperative systolic blood pressure (SBP), and plasma aldosterone concentration (PAC) were predictors of postoperative renal function deterioration. KCNJ5 wild-type status was significantly correlated with the occurrence of chronic kidney disease after adrenalectomy.

Conclusions: Unilateral adrenalectomy demonstrates favorable biochemical and clinical outcomes in patients with primary aldosteronism, irrespective of age. Long-term eGFR decline is similar among the different age groups. KCNJ5 mutation exhibits a protective effect against the risk of chronic kidney disease after unilateral adrenalectomy.

Keywords: KCNJ5 mutation; adrenalectomy; age; estimated glomerular filtration rate; primary aldosteronism.

MeSH terms

Adrenalectomy* / adverse effects
Adult
Age Factors
Aged
Female
Follow-Up Studies
G Protein-Coupled Inwardly-Rectifying Potassium Channels / genetics
Glomerular Filtration Rate*
Humans
Hyperaldosteronism* / surgery
Kidney / physiopathology
Kidney Function Tests
Male
Middle Aged
Postoperative Complications / etiology
Retrospective Studies
Treatment Outcome

Substances

G Protein-Coupled Inwardly-Rectifying Potassium Channels
KCNJ5 protein, human

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the National Natural Science Foundation of China (8190149, U21A20354) and received a grant from the Shanghai Commission of Health (20214Y0229).