MP03-07 ADRENALECTOMY ATTENUATES THE RISK OF END STAGE RENAL DISEASE OF PRIMARY ALDOSTERONISM – A COMPETING RISK ANALYSIS

Abstract

You have accessJournal of UrologyAdrenal1 Apr 2018MP03-07 ADRENALECTOMY ATTENUATES THE RISK OF END STAGE RENAL DISEASE OF PRIMARY ALDOSTERONISM – A COMPETING RISK ANALYSIS Chin-Fong AU, Shiu-Dong Chung, and Vin-Cent WU Chin-Fong AUChin-Fong AU More articles by this author , Shiu-Dong ChungShiu-Dong Chung More articles by this author , and Vin-Cent WUVin-Cent WU More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.3050AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Primary aldosteronism (PA) is a common type of secondary hypertension. It is associated with poor clinical outcome without appropriate treatment. We studied the long-term effect of aldosterone excess on kidney function after targeted treatment. METHODS We used a longitudinal population database from the Taiwan National Health Insurance system and performed a validated algorithm to identify PA patients diagnosed between 1997 and 2009. There were 2699 PA patients recruited, among whom 761 aldosterone-producing adenoma (APA) patients were identified. There were a total of 10796 essential hypertension (EH) control patients, recruited via propensity-score match, including the APA subgroup controls. Our methods for assessing the targeted treatment on the incident end stage renal disease (ESRD) included multivariable Cox regression and competing risk regression. RESULTS The incidence rate of ESRD was 3% for PA patients after targeted treatment, with 5.2 years of follow-up, and was compatible to the EH controls. Taking mortality as a competing risk, there was significantly lower incidence of ESRD PA versus EH (subdistribution hazard ratio (sHR) 0.38, p= 0.007) and APA versus EH (sHR 0.55, p= 0.021) after adrenalectomy, while there was no significant difference in PA patients receiving mineralocorticoid receptor antagonists (MRA) when compared with EH controls. There was also a significantly lower incidence of mortality among PA and APA patients who underwent adrenalectomy when compared with EH controls (p< 0.001). CONCLUSIONS The patients with PA/APA undergoing adrenalectomy had better longterm outcomes regarding progression to ESRD and mortality than the hypertensive controls, but MRA treatment did not significantly affect outcome. These results suggest the crucial importance of early diagnosis and targeted treatment of PA with regard to kidney function. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e24 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Chin-Fong AU More articles by this author Shiu-Dong Chung More articles by this author Vin-Cent WU More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...