Login to Access Video or Poster Abstract: MP37-05
Sources of Funding: none

Introduction

In patients with primary aldosteronism (PA), excessive aldosterone causes glomerular hyperfiltration, which can be associated with increase in glomerular filtration ratio (GFR). After treatment of PA, correction of hyperfiltration may decrease GFR. Therefore, decrement in GFR can be a clinically significant problem after treatment of PA. The aim of this study was to determine the prevalence of renal deterioration and new onset chronic kidney disease (CKD), and identify the predictors of decreasing estimated GFR (eGFR) after laparoscopic adrenalectomy for aldosterone-producing adenoma.

Methods

In our institution, 64 patients underwent laparoscopic adrenalectomy for PA between 2001 and 2015. Of them, 41 patients who received postoperative surveillance for more than 12 months were included in this retrospective study. Preoperative parameters including age, sex, duration of hypertension, eGFR, the ratio of plasma aldosterone (pg/mL) to plasma renin activity (ng/mL/hr) ratio (ARR), tumor size and operation time were evaluated to determine risk factors for postoperative deterioration of eGFR (>25% decrement from preoperative level) and new onset CKD (eGFR <60 ml/min/1.73m2).

Results

Median followup was 58 months (range 12-187). Mean preoperative eGFR was significantly decreased from 73.6 ± 19.7 ml/min/1.73m2 at baseline to 61.0 ± 18.9 ml/min/1.73m2 at the latest followup (p<0.01). Fifteen patients (36.6%) showed postoperative deterioration of eGFR. ARR was the only significant predictive factor for postoperative deterioration of eGFR. Using a cutoff point of 2000, sensitivity and specificity were 62.5% and 77.2%, respectively. Excluding 11 patients who had CKD before operation, 13 (43.3%) of 30 patients developed new onset CKD after operation. We could not determine a significant predictor for postoperative new onset CKD.

Conclusions

Postoperative renal deterioration is prevalent in patients with PA. High ARR may be associated with the degree of glomerular hyperfiltration and irreversible renal damage and is a predictive factor of eGFR decrement after removal of adenoma. Postoperative surveillance of renal function and management of CKD are essential in patients who underwent adrenalectomy for PA.

Funding

none