Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism (Endocrinol Metab 2021;36:875-84, Ye Seul Yang et al.)

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Endocrinol Metab. 2022;37(6):953-954

Publication date (electronic) : 2022 December 12

doi : https://doi.org/10.3803/EnM.2022.603

Ye Seul Yang ¹

, Sang Wan Kim^,²^,³

¹Department of Medicine, Seoul National University College of Medicine, Seoul, Korea

²Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

³Division of Endocrinology and Metabolism, Boramae Medical Center, Seoul, Korea

Corresponding author: Sang Wan Kim. Department of Internal Medicine, Seoul National University College of Medicine and Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea Tel: +82-2-870-2223, Fax: +82-2-870-3863, E-mail: swkimmd@snu.ac.kr

Received 2022 December 5; Accepted 2022 December 12.

We thank Tan et al. for their interest in our study and for their effort to elaborate on the association between age and chronic kidney disease (CKD) after adrenalectomy in patients with primary aldosteronism (PA). We demonstrated that a contralateral suppression index (CSI) ≤0.26 at adrenal venous sampling was associated with incident CKD, especially in patients >50 years of age, after adrenalectomy [1]. We determined the cut-off age for this study by performing a receiver operating characteristic curve analysis.

We agree with their interest in differences between elderly patients and nonelderly patients regarding renal outcomes after adrenalectomy. In our study population, the prevalence of postoperative CKD, which was defined as a postoperative estimated glomerular filtration rate (GFR) less than 60 mL/min/1.73 m² in cases where the preoperative GFR was ≥60 mL/min/1.73 m², and post-adrenalectomy hyperkalemia was higher in the elderly group (≥60 years old, n=55) than in the nonelderly group (<60 years old, n=208) (P=0.041 and P=0.011, respectively), even though the prevalence of preoperative CKD was comparable between groups. However, there were no significant differences in renal outcomes except for GFR after adrenalectomy, when patients ≥65 years of age were defined as elderly. This might have been due to the small size of the population, as only 28 (10.6%) patients were ≥65 years old.

The elderly group had a longer duration of hypertension (11.1 years vs. 6.3 years, P<0.001), lower diastolic blood pressure (82.1 mm Hg vs. 92.7 mm Hg, P<0.001), a lower preoperative GFR (75.6 mL/min/1.73 m² vs. 87.8 mL/min/1.73 m², P<0.001), a lower plasma aldosterone-to-renin ratio (136.8 ng/dL per ng/mL/hr vs. 216.5 ng/dL per ng/mL/hr, P=0.015), and higher CSI (0.25 vs. 0.20, P=0.022) than the nonelderly group. However, logistic regression analysis showed that only the CSI significantly predicted renal impairment in the elderly group.

A recent study also showed that contralateral suppression, baseline plasma aldosterone, and female sex were associated with decreased GFR after adrenalectomy in patients with PA [2]. In our study [1], age was associated with renal impairment in the univariate analysis (P=0.03), but was not significant after adjusting for the CSI in the multivariate analysis (P=0.072). Therefore, the CSI is considered to be a more important factor in the deterioration of renal function after adrenalectomy than the patient’s age itself. It would be interesting to study the effect of the CSI on renal impairment in various age groups from other study populations [3-7]. We deeply appreciate the valuable insights of Tan et al., which have broadened the understanding of our article.

Notes

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

References

1. Yang YS, Lee SH, Kim JH, Yoo JH, Lee JH, Lee SY, et al. Contralateral suppression at adrenal venous sampling is associated with renal impairment following adrenalectomy for unilateral primary aldosteronism. Endocrinol Metab (Seoul) 2021;36:875–84.

2. Voss N, Morup S, Clausen C, Feltoft CL, Jepsen JV, Hornum M, et al. Prognostic value of contralateral suppression on kidney function after surgery in patients with primary aldosteronism. Clin Endocrinol (Oxf) 2022;Oct. 20. [Epub]. https://doi.org/10.1111/cen.14836.

3. Kim DH, Kwon HJ, Ji SA, Jang HR, Jung SH, Kim JH, et al. Risk factors for renal impairment revealed after unilateral adrenalectomy in patients with primary aldosteronism. Medicine (Baltimore) 2016;95e3930.

4. Kim IY, Park IS, Kim MJ, Han M, Rhee H, Seong EY, et al. Change in kidney function after unilateral adrenalectomy in patients with primary aldosteronism: identification of risk factors for decreased kidney function. Int Urol Nephrol 2018;50:1887–95.

5. Utsumi T, Kawamura K, Imamoto T, Nagano H, Tanaka T, Kamiya N, et al. Preoperative masked renal damage in Japanese patients with primary aldosteronism: identification of predictors for chronic kidney disease manifested after adrenalectomy. Int J Urol 2013;20:685–91.

6. Ren X, Shang J, Ren R, Ma D. Analysis of the influencing factors for postoperative chronic kidney insufficiency in patients with primary aldosteronism. Chin J Urol 2020;41:731–5.

7. Takeda M, Yamamoto K, Akasaka H, Rakugi H, Naruse M, Takeda Y, et al. Clinical characteristics and postoperative outcomes of primary aldosteronism in the elderly. J Clin Endocrinol Metab 2018;103:3620–9.

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