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Risk Factors Associated with a Low Glomerular Filtration Rate in Primary Aldosteronism

Medizinische Klinik Innenstadt (M.R., C.S., F.B., M.B., S.E.) and Institut für Prophylaxe und Epidemiologie der Kreislaufkrankheiten (R.L.), Ludwig-Maximilians-Universität München, 80336 München, Germany; Klinik für Nephrologie (L.C.R.), Universitätsklinikum Düsseldorf,40225 Dusseldorf, Germany; Klinische Endokrinologie (M.Q.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany; Medizinische Klinik und Poliklinik I (S.H.), Julius-Maximilians-Universität, 97080 Würzburg, Germany; Endokrinologikum (S.D.), 10117 Berlin, Germany; Medizinische Klinik II (J.S.), Albert-Ludwigs-Universität, 79106 Freiburg, Germany; Institute of Epidemiology (C.M.), Helmholtz Zentrum München, 85764 Neuherberg, Germany; and Institute of Health Economics and Health Care Management (R.H.), Helmholtz Zentrum München, 85764 Neuherberg, Germany

Address all correspondence and requests for reprints to: Prof. Dr. M. Reincke, Medizinische Klinik–Innenstadt, Klinikum der Universität München, Ziemssenstr. 1, 80336 München, Germany. E-mail: martin.reincke{at}med.uni-muenchen.de.

Context: Primary aldosteronism (PA) is associated with vascular end organ damage.

Objective: We evaluated the newly established German Conn’s Registry for evidence of renal impairment and compared the data with those from hypertensive subjects of a population-based survey.

Design: We conducted a case-control study.

Patients and Controls: A total of 408 patients with PA from the Conn’s registry treated in five German centers were matched for age, sex, and body mass index in a 1:1 ratio with 408 hypertensive control subjects from the population-based F3 survey of the Kooperative Gesundheitsforschung in the region of Augsburg (KORA).

Main Outcome Measures: We measured serum creatinine and calculated glomerular filtration rate (GFR).

Results: The percentage of patients with a serum creatinine concentration above the normal range of 1.25 mg/dl was higher in patients with PA than in hypertensive controls (29 vs. 10%; P < 0.001). Regression analysis showed that age, male sex, low potassium, and high aldosterone concentrations were independent predictors of a lower GFR. Adrenalectomy reduced systolic blood pressure from a mean of 160 to 144 mm Hg. In parallel, we observed an increase in serum creatinine and a decrease of GFR from 71 to 64 ml/min (P < 0.001). A similar trend was seen after spironolactone treatment.

Conclusions: In a large cohort of patients with PA, markers of disease activity such as plasma aldosterone and serum potassium are independent predictors of a lower GFR. Specific interventions, such as adrenalectomy or spironolactone treatment, are associated with a further decline in GFR.