Association of Kidney Function With Residual Hypertension After Treatment of Aldosterone-Producing Adenoma

Vin Cent Wu; Shih Chieh Chueh; Hung Wei Chang; Lian Yu Lin; Kao Lang Liu; Yen Hung Lin; Yi Luwn Ho; Wei Chou Lin; Shuo Meng Wang; Kuo How Huang; Kuan Yu Hung; Tze Wah Kao; Shuei Liong Lin; Ruoh Fang Yen; Yung Ming Chen; Bor Sen Hsieh; Kwan Dun Wu

doi:10.1053/j.ajkd.2009.06.014

Association of Kidney Function With Residual Hypertension After Treatment of Aldosterone-Producing Adenoma

Vin Cent Wu, Shih Chieh Chueh, Hung Wei Chang, Lian Yu Lin, Kao Lang Liu, Yen Hung Lin, Yi Luwn Ho, Wei Chou Lin, Shuo Meng Wang, Kuo How Huang, Kuan Yu Hung, Tze Wah Kao, Shuei Liong Lin, Ruoh Fang Yen, Yung Ming Chen, Bor Sen Hsieh, Kwan Dun Wu

Research output: Contribution to journal › Article › peer-review

91 Citations (Scopus)

Abstract

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. Predictor: Presurgery estimated glomerular filtration rate (eGFR). Outcomes & Measurements: 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.

Original language	English
Pages (from-to)	665-673
Number of pages	9
Journal	American Journal of Kidney Diseases
Volume	54
Issue number	4
DOIs	https://doi.org/10.1053/j.ajkd.2009.06.014
Publication status	Published - Oct 2009
Externally published	Yes

Keywords

adrenalectomy
glomerular filtration rate
Primary aldosteronism
residual hypertension

ASJC Scopus subject areas

Nephrology

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10.1053/j.ajkd.2009.06.014

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Wu, V. C., Chueh, S. C., Chang, H. W., Lin, L. Y., Liu, K. L., Lin, Y. H., Ho, Y. L., Lin, W. C., Wang, S. M., Huang, K. H., Hung, K. Y., Kao, T. W., Lin, S. L., Yen, R. F., Chen, Y. M., Hsieh, B. S., & Wu, K. D. (2009). Association of Kidney Function With Residual Hypertension After Treatment of Aldosterone-Producing Adenoma. American Journal of Kidney Diseases, 54(4), 665-673. https://doi.org/10.1053/j.ajkd.2009.06.014

Wu, VC, Chueh, SC, Chang, HW, Lin, LY, Liu, KL, Lin, YH, Ho, YL, Lin, WC, Wang, SM, Huang, KH, Hung, KY, Kao, TW, Lin, SL, Yen, RF, Chen, YM, Hsieh, BS & Wu, KD 2009, 'Association of Kidney Function With Residual Hypertension After Treatment of Aldosterone-Producing Adenoma', American Journal of Kidney Diseases, vol. 54, no. 4, pp. 665-673. https://doi.org/10.1053/j.ajkd.2009.06.014

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title = "Association of Kidney Function With Residual Hypertension After Treatment of Aldosterone-Producing Adenoma",

abstract = "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. Predictor: Presurgery estimated glomerular filtration rate (eGFR). Outcomes & Measurements: 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.",

keywords = "adrenalectomy, glomerular filtration rate, Primary aldosteronism, residual hypertension",

author = "Wu, {Vin Cent} and Chueh, {Shih Chieh} and Chang, {Hung Wei} and Lin, {Lian Yu} and Liu, {Kao Lang} and Lin, {Yen Hung} and Ho, {Yi Luwn} and Lin, {Wei Chou} and Wang, {Shuo Meng} and Huang, {Kuo How} and Hung, {Kuan Yu} and Kao, {Tze Wah} and Lin, {Shuei Liong} and Yen, {Ruoh Fang} and Chen, {Yung Ming} and Hsieh, {Bor Sen} and Wu, {Kwan Dun}",

year = "2009",

month = oct,

doi = "10.1053/j.ajkd.2009.06.014",

language = "English",

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pages = "665--673",

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T1 - Association of Kidney Function With Residual Hypertension After Treatment of Aldosterone-Producing Adenoma

AU - Wu, Vin Cent

AU - Chueh, Shih Chieh

AU - Chang, Hung Wei

AU - Lin, Lian Yu

AU - Liu, Kao Lang

AU - Lin, Yen Hung

AU - Ho, Yi Luwn

AU - Lin, Wei Chou

AU - Wang, Shuo Meng

AU - Huang, Kuo How

AU - Hung, Kuan Yu

AU - Kao, Tze Wah

AU - Lin, Shuei Liong

AU - Yen, Ruoh Fang

AU - Chen, Yung Ming

AU - Hsieh, Bor Sen

AU - Wu, Kwan Dun

PY - 2009/10

Y1 - 2009/10

N2 - 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. Predictor: Presurgery estimated glomerular filtration rate (eGFR). Outcomes & Measurements: 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.

AB - 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. Predictor: Presurgery estimated glomerular filtration rate (eGFR). Outcomes & Measurements: 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.

KW - adrenalectomy

KW - glomerular filtration rate

KW - Primary aldosteronism

KW - residual hypertension

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Association of Kidney Function With Residual Hypertension After Treatment of Aldosterone-Producing Adenoma

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