Aldosterone and glomerular filtration – observations in the general population

Anke Hannemann,Karlhans Endlich,Rainer Rettig,Henri Wallaschofski,Kathleen Dittmann,Matthias Nauck,Henry Völzke

doi:10.1186/1471-2369-15-44

Anke Hannemann, Karlhans Endlich + Show 5 more

Open Access

https://doi.org/10.1186/1471-2369-15-44

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Journal: BMC Nephrology	Publication Date: Mar 10, 2014
Citations: 59	License type: cc-by

Affiliation: Greifswald University Hospital

Abstract

BackgroundIncreasing evidence suggests that aldosterone promotes renal damage. Since data on the association between aldosterone and renal function in the general population are sparse, we chose to address this issue. We investigated the associations between the plasma aldosterone concentration (PAC) or the aldosterone-to-renin ratio (ARR) and the estimated glomerular filtration rate (eGFR) in a sample of adult men and women from Northeast Germany.MethodsA study population of 1921 adult men and women who participated in the first follow-up of the Study of Health in Pomerania was selected. None of the subjects used drugs that alter PAC or ARR. The eGFR was calculated according to the four-variable Modification of Diet in Renal Disease formula. Chronic kidney disease (CKD) was defined as an eGFR <60 ml/min/1.73 m2.ResultsLinear regression models, adjusted for sex, age, waist circumference, diabetes mellitus, smoking status, systolic and diastolic blood pressures, serum triglyceride concentrations and time of blood sampling revealed inverse associations of PAC or ARR with eGFR (ß-coefficient for log-transformed PAC −3.12, p < 0.001; ß-coefficient for log-transformed ARR −3.36, p < 0.001). Logistic regression models revealed increased odds for CKD with increasing PAC (odds ratio for a one standard deviation increase in PAC: 1.35, 95% confidence interval: 1.06-1.71). There was no statistically significant association between ARR and CKD.ConclusionOur study demonstrates that PAC and ARR are inversely associated with the glomerular filtration rate in the general population.

Highlights

Increasing evidence suggests that aldosterone promotes renal damage
In analyses of variance models, plasma aldosterone concentration (PAC) and aldosterone-to-renin ratio (ARR) but not PRC were inversely associated with estimated glomerular filtration rate (eGFR) (Figure 1)
The adjusted mean eGFR was significantly lower in subjects with PAC or ARR in the second or third tertile than in subjects with PAC or ARR in the first tertile

Summary

Introduction

Increasing evidence suggests that aldosterone promotes renal damage. The prevalence of chronic kidney disease (CKD) increases worldwide [1,2]. An impaired renal function is associated with an increased risk of cardiovascular disease and mortality [3,4]. In a large longitudinal study [5] including more than one million subjects from the San Francisco Bay area, a graded association between the eGFR and the risk of cardiovascular events and death was detected. Increasing evidence suggests that the renin-angiotensin-aldosterone system (RAAS) is involved in linking the metabolic syndrome, CKD and cardiovascular disease [7,8]. A condition characterized by excessive and largely autonomous aldosterone secretion, is associated with a high prevalence of renal damage [10,11,12]. The treatment of patients with primary aldosteronism with aldosterone antagonists such as spironolactone or eplerenone or with adrenalectomy may reduce renal damage and prevent cardiovascular events [13]

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