Prognostic value of contralateral suppression on kidney function after surgery in patients with primary aldosteronism

Background and objective: Adrenalectomy for primary aldosteronism (PA) has been associated with decreased kidney function after surgery. It has been proposed that elimination of excess aldosterone unmasks an underlying failure of the kidney function. Contralateral suppression (CLS) is considered a m...

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Published in:Clinical endocrinology (Oxford) 2023-03, Vol.98 (3), p.306-314
Main Authors: Voss, Nathalie, Mørup, Sara, Clausen, Caroline, Feltoft, Claus larsen, Jepsen, Jan Viberg, Hornum, Mads, Andreassen, Mikkel, Krogh, Jesper
Format: Article
Language:English
Subjects:
Adrenal Glands
adrenal venous sampling
Adrenalectomy
Aldosterone
contralateral suppression
Endocrine disorders
Epidermal growth factor receptors
estimated glomerular filtration rate
Glomerular filtration rate
Humans
hyperaldosteronism
Hyperaldosteronism - surgery
Hyperkalemia
Hyperkalemia - etiology
Hyperkalemia - surgery
hypertension
Kidney - surgery
kidney function
Kidneys
Medical treatment
Multivariate analysis
Patients
primary aldosteronism
Prognosis
Renal failure
Retrospective Studies
Surgery
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Summary:Background and objective: Adrenalectomy for primary aldosteronism (PA) has been associated with decreased kidney function after surgery. It has been proposed that elimination of excess aldosterone unmasks an underlying failure of the kidney function. Contralateral suppression (CLS) is considered a marker of aldosterone excess and disease severity, and the purpose of this study was to assess the hypothesis that CLS would predict change in kidney function after adrenalectomy in patients with PA. Design and patients: Patients with PA referred for adrenal venous sampling (AVS) between May 2011 and August 2021 and who were subsequently offered surgical or medical treatment were eligible for the current study. Results: A total of 138 patients were included and after AVS 85/138 (61.6%) underwent adrenalectomy while 53/138 (38.4%) were treated with MR‐antagonists. In surgically treated patients the estimated glomerular filtration rate (eGFR) was reduced by 11.5 (SD: 18.5) compared to a reduction of 5.9 (SD: 11.5) in medically treated patients (p = .04). Among surgically treated patients, 59/85 (69.4%) were classified as having CLS. After adrenalectomy, patients with CLS had a mean reduction in eGFR of 17.5 (SD: 17.6) compared to an increase of 1.8 (SD: 12.8) in patients without CLS (p 
ISSN:0300-0664
1365-2265
DOI:10.1111/cen.14836