PD31-01 NOBEL NOMOGRAMS TO PREDICT RENAL DAMAGE AFTER LAPAROSCOPIC ADRENALECTOMY IN PATIENTS WITH PRIMARY ALDOSTERONISM

Abstract

INTRODUCTION AND OBJECTIVE: Most patients with primary aldosteronism (PA) show a significant decline in kidney function postoperatively. However, correct interpretation of renal function in PA patients can be difficult using conventional estimated glomerular filtration rates (eGFR) preoperatively, because, in patients at an early stage, subtle kidney impairment is masked by the glomerular hyperfiltration. The aim of this study was to investigate postoperative renal damage and cardiometabolic risks (lipid profiles and uricemia) in PA patients and to develop novel nomograms that can predict renal damage in PA patients after surgery. METHODS: N= 135 PA patients treated by unilateral laparoscopic adrenalectomy were retrospectively surveyed. Pre- and postoperative changes of eGFRs, lipid profiles and uricemia were compared. Moreover, predictors of the following renal functional outcomes were investigated: (1) the percentage decrease >25% in eGFR and (2) the presence of new-onset eGFR <45 ml/min/1.73 m2 (eGFR stage ≥G3b). Last, two nomograms that predicted postoperative renal damage were developed and internally validated. RESULTS: eGFR, lipid profiles and uricemia significantly deteriorated at 6 months after surgery. The average eGFR decrease was 17.4 mL/min/1.73 m2 (corresponding percent decrease: 20.5%). A >25% postoperative decrease in eGFR was observed in 52 patients. Age, potassium, plasma aldosterone concentration, and initial eGFR were incorporated into a nomogram predicting a >25% postoperative decrease in eGFR (nomogram1). Upstaging of eGFR classification was observed in 56.3% of patients. New-onset eGFR <45 ml/min/1.73 m2 was observed in 18 patients. Duration of hypertension and initial eGFR were incorporated into a nomogram predicting new-onset eGFR <45 ml/min/1.73 m2 (nomogram2). The value of the area under the curve for each nomogram was 0.84 and 0.80, respectively. CONCLUSIONS: PA patients undergoing laparoscopic adrenalectomy have a higher risk of diverse renal damage and cardiometabolic risks. Postoperative cardiometabolic risks, such as worsening hypertriglyceridemia and hypercholesterolemia, were found to be accompanied with unmasked renal damage in PA patients. These nomograms can help clinicians identify and manage PA patients more effectively with a greater risk of renal dysfunction and cardiometabolic disease after laparoscopic adrenalectomy. Source of Funding: A Grant for Medical Research, Yoko Shibata Memorial Foundation, Toho University.