Association of the ratio of visceral-to-subcutaneous fat volume with renal function among patients with primary aldosteronism

Tatsuya Haze,Shiro Komiya,Yuki Ohki,Akira Fujiwara,Rina Kawano,Kouichi Tamura,Shota Suzuki,Yusuke Kobayashi,Sanae Saka,Moe Hatakeyama,Nobuhito Hirawa

doi:10.1038/s41440-021-00719-w

Tatsuya Haze, Shiro Komiya + Show 9 more

Open Access

https://doi.org/10.1038/s41440-021-00719-w

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Abstract

Patients with primary aldosteronism have a higher risk of chronic kidney disease. Visceral fat tissue is hypothesized to stimulate the adrenal glands to overproduce aldosterone, and aldosterone promotes visceral fat tissue to produce inflammatory cytokines. However, it is unclear whether the volume of accumulated visceral fat tissue is associated with renal impairment among patients with hyperaldosteronism. We conducted a single-center cross-sectional study to assess the association between the estimated glomerular filtration rate and the ratio of the visceral-to-subcutaneous fat volume calculated by computed tomography. One hundred eighty patients with primary aldosteronism were enrolled. The mean ± SD age was 52.7 ± 11.0 years, and 60.0% were women. The ratio of visceral-to-subcutaneous fat volume was highly correlated with the estimated glomerular filtration rate (r = 0.49, p < 0.001). In multiple linear regression models, the ratio of visceral-to-subcutaneous fat tissue volume was significantly associated with the estimated glomerular filtration rate (estimates: −4.56 mL/min/1.73 m² per 1-SD), and there was an interaction effect between the plasma aldosterone concentration and the ratio of visceral-to-subcutaneous fat volume (p < 0.05). The group with a higher plasma aldosterone concentration exhibited a steeper decline in eGFR than the lower plasma aldosterone concentration group when the ratio increased. The ratio of visceral-to-subcutaneous fat tissue volume was an independent risk factor for renal dysfunction. This association increased in the presence of a high plasma aldosterone concentration. Clinicians should pay attention to the ratio of visceral-to-subcutaneous fat tissue volume and encourage primary aldosteronism patients to improve their lifestyle in addition to treating renin-aldosterone activity.

Highlights

Primary aldosteronism (PA) is caused by aldosterone overproduction from the adrenal glands and is the most common cause of secondary hypertension, with an estimated prevalence of 5–20% in hypertensive patients [1, 2]
We selected individuals (1) who were diagnosed with PA or essential hypertension (EH), (2) who had not been treated by adrenalectomy or mineralocorticoid receptor antagonist (MRA), and (3) whose records included an assessment of the estimated glomerular filtration rate and computed tomography (CT) findings
Scatter plots of estimated glomerular filtration rate (eGFR) and the VF volume (VFV)/SF volume (SFV) ratio are shown in Supplementary Figure 4. In this single-center cross-sectional observational study, the abdominal VFV/SFV ratio was significantly associated with renal function in patients with PA

Summary

Introduction

Primary aldosteronism (PA) is caused by aldosterone overproduction from the adrenal glands and is the most common cause of secondary hypertension, with an estimated prevalence of 5–20% in hypertensive patients [1, 2]. Patients with PA have an increased risk of kidney diseases compared with patients with essential hypertension (EH) [5]. Adrenalectomy or mineralocorticoid receptor antagonist (MRA) treatment is recommended for patients with PA [2]. Patients with PA treated by MRA exhibit a faster decline in renal function than those with EH [6]. It is important to clarify the risk factors for renal failure in patients with PA and identify methods to improve their renal prognosis

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