CONTEXT: Chronic kidney disease (CKD) is sometimes unmasked after unilateral adrenalectomy in patients with primary aldosteronism (PA) without expectation. OBJECTIVE: Our study aim was to elucidate factors responsible for developing postoperative CKD and to provide a simple scoring system to predict postoperative CKD in PA. DESIGN AND PATIENTS: Forty-five patients with PA treated with unilateral adrenalectomy and followed for at least 1 month postsurgery were studied. Thirty-one patients with non-PA adrenal disease who underwent unilateral adrenalectomy were also studied as control. Patients with pre-operative estimated glomerular filtration rate (eGFR) < 60 ml/min/1·73 m(2) were excluded from both groups. RESULTS: A statistically significant (P < 0·001) decrease in eGFR was observed in PA group within 1 month of surgery, then stabilized. Of the 45 patients with PA, 17 (37·8%) developed CKD after surgery. None of the non-PA group developed CKD after surgery. Of the pre-operative variables, logistic regression analysis showed that lower eGFR and higher aldosterone-to-renin ratios (ARR) were the independent predictors for postoperative CKD in PA. Optimal cut-off values of the two variables analysed with ROC curves were as follows: eGFR ≤ 76·9 ml/min/1·73 m(2) and ARR ≥ 305. Using these data, we created a CKD score as a tool for predicting postoperative CKD, with an AUC for the score of 0·8866. CONCLUSION: The pre-operative eGFR and ARR were the significant contributing factors for postoperative CKD in PA. By combining these independent factors, we created a CKD score which provides useful information before surgery about the risk for development of postoperative CKD.
CONTEXT: Chronic kidney disease (CKD) is sometimes unmasked after unilateral adrenalectomy in patients with primary aldosteronism (PA) without expectation. OBJECTIVE: Our study aim was to elucidate factors responsible for developing postoperative CKD and to provide a simple scoring system to predict postoperative CKD in PA. DESIGN AND PATIENTS: Forty-five patients with PA treated with unilateral adrenalectomy and followed for at least 1 month postsurgery were studied. Thirty-one patients with non-PA adrenal disease who underwent unilateral adrenalectomy were also studied as control. Patients with pre-operative estimated glomerular filtration rate (eGFR) < 60 ml/min/1·73 m(2) were excluded from both groups. RESULTS: A statistically significant (P < 0·001) decrease in eGFR was observed in PA group within 1 month of surgery, then stabilized. Of the 45 patients with PA, 17 (37·8%) developed CKD after surgery. None of the non-PA group developed CKD after surgery. Of the pre-operative variables, logistic regression analysis showed that lower eGFR and higher aldosterone-to-renin ratios (ARR) were the independent predictors for postoperative CKD in PA. Optimal cut-off values of the two variables analysed with ROC curves were as follows: eGFR ≤ 76·9 ml/min/1·73 m(2) and ARR ≥ 305. Using these data, we created a CKD score as a tool for predicting postoperative CKD, with an AUC for the score of 0·8866. CONCLUSION: The pre-operative eGFR and ARR were the significant contributing factors for postoperative CKD in PA. By combining these independent factors, we created a CKD score which provides useful information before surgery about the risk for development of postoperative CKD.
Authors: Il Young Kim; In Seong Park; Min Jeong Kim; Miyeun Han; Harin Rhee; Eun Young Seong; Dong Won Lee; Soo Bong Lee; Ihm Soo Kwak; Sang Heon Song; Hyun Chul Chung Journal: Int Urol Nephrol Date: 2018-05-19 Impact factor: 2.370