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Kidney function predicts new-onset cardiorenal events and mortality in primary aldosteronism: approach of the 2021 race-free eGFR equation

Hypertension Research volume 47, pages 233–244 (2024)Cite this article

Abstract

Individuals with primary aldosteronism (PA) exhibit glomerular hyperfiltration, which may conceal underlying kidney damage. This observational cohort study enrolled 760 coronary artery disease-naive patients diagnosed with PA between January 1, 2007 and December 31, 2018 (male, 45%; mean age, 52.3 ± 11.9 years). The baseline estimated glomerular filtration rate (eGFR) was calculated using the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, which includes serum creatinine and cystatin C but omits the race variable. During a mean follow-up of 5.8 ± 3.2 years, new-onset composite cardiovascular events (total death, non-fatal myocardial infarction, and coronary revascularization procedure) occurred at a crude incidence rate of 10.9 per 1,000 person-years. Multivariable Cox proportional hazards analysis showed that baseline eGFR was independently associated with composite cardiovascular events (hazard ratio [HR], 0.98 [95% CI, 0.97–0.99]). Penalized splines smoothing in multivariable regression analysis demonstrated that the risk of composite cardiovascular events increased negatively and linearly when patients had a baseline eGFR less than 85 mL/min/1.73 m2. Patients with baseline eGFR <85 mL/min/1.73 m2 were independently associated with higher risks of composite cardiovascular events (HR, 2.39 [95% CI, 1.16–4.93]), all-cause mortality (HR, 4.63 [95% CI, 1.59–13.46]), and adverse kidney events (sub-distribution HR, 5.96 [95% CI, 3.69–9.62], with mortality as a competing risk). Our data support baseline eGFR as a predictor for new-onset adverse cardiorenal events and emphasizes the importance of the early detection of kidney function impairment in hypertensive patients with PA. We also firstly validate the 2021 race-free CKD-EPI eGFR equation in Asian patents with PA.

Even with the glomerular hyperfiltration phenomenon, baseline eGFR in patients with primary aldosteronism is associated with subsequent cardiorenal outcomes. The results also firstly point to the validity of the 2021 race-free CKD-EPI eGFR equation in healthcare and clinical decision-making.

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Acknowledgements

The authors thank Miss Fang-Yu Yeh for her assistant in statistical analysis. The authors also thank the staff of the Second and Seventh Core Labs, Department of Medical Research at National Taiwan University Hospital for technical assistance. The authors express sincere gratitude to all staffs of the Taiwan Clinical Trial Consortium (TCTC).

the TAIPAI study group

Vin-Cent Wu1,3, Tai-Shuan Lai1, Jeff S. Chueh4, Shao-Yu Yang1, Kao-Lang Liu5, Chin-Chen Chang5, Bo-Ching Lee5, Shuo-Meng Wang4, Kuo-How Huang4, Po-Chih Lin2, Yen-Hung Lin2,3, Chi-Sheng Hung2, Lian-Yu Lin2,6, Shih-Cheng Liao5, Ching-Chu Lu5, Chieh-Kai Chan7, Leay-Kiaw Er8, Ya-Hui Hu8, Che-Hsiung Wu8, Yao-Chou Tsai8, Zheng-Wei Chen6, Chien-Ting Pan6, Che-Wei Liao9, Cheng-Hsuan Tsai2, Yi-Yao Chang10, Chen-Hsun Ho11, Wei-Chieh Huang12, Ying-Ying Chen13

Funding

This work was supported by the National Science and Technology Council, Taiwan (110-2314-B-002-239, 110-2314-B-002-241); National Health Research Institutes, Taiwan (PH 102-SP-09); National Taiwan University Hospital (109-S4634, UN109-041, UN110-030); Ministry of Health and Welfare, Taiwan (110-TDU-B-212-124005); Mrs. Hsiu-Chin Lee Kidney Research Fund. The funds played no role in the study design, data collection, analysis and interpretation, manuscript writing or in the decision to submit this manuscript for publication.

Author information

Authors and Affiliations

  1. Renal Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Chun-Fu Lai, Vin-Cent Wu, Tai-Shuan Lai & Shao-Yu Yang

  2. Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Yen-Hung Lin, Po-Chih Lin, Chi-Sheng Hung, Lian-Yu Lin & Cheng-Hsuan Tsai

  3. Primary Aldosteronism Center, National Taiwan University Hospital, Taipei, Taiwan

    Yen-Hung Lin & Vin-Cent Wu

  4. Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Kuo-How Huang, Jeff S. Chueh & Shuo-Meng Wang

  5. National Taiwan University Hospital, Taipei, Taiwan

    Kao-Lang Liu, Chin-Chen Chang, Bo-Ching Lee, Shih-Cheng Liao & Ching-Chu Lu

  6. Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan

    Lian-Yu Lin, Zheng-Wei Chen & Chien-Ting Pan

  7. Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan

    Chieh-Kai Chan

  8. Taipei Tzu-Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan

    Leay-Kiaw Er, Ya-Hui Hu, Che-Hsiung Wu & Yao-Chou Tsai

  9. Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan

    Che-Wei Liao

  10. Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Yi-Yao Chang

  11. Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

    Chen-Hsun Ho

  12. Taipei Veterans General Hospital, Taipei, Taiwan

    Wei-Chieh Huang

  13. MacKay Memorial Hospital, Taipei, Taiwan

    Ying-Ying Chen

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  1. Chun-Fu Lai
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Consortia

the TAIPAI study group

  • Vin-Cent Wu
  • , Tai-Shuan Lai
  • , Jeff S. Chueh
  • , Shao-Yu Yang
  • , Kao-Lang Liu
  • , Chin-Chen Chang
  • , Bo-Ching Lee
  • , Shuo-Meng Wang
  • , Kuo-How Huang
  • , Po-Chih Lin
  • , Yen-Hung Lin
  • , Chi-Sheng Hung
  • , Lian-Yu Lin
  • , Shih-Cheng Liao
  • , Ching-Chu Lu
  • , Chieh-Kai Chan
  • , Leay-Kiaw Er
  • , Ya-Hui Hu
  • , Che-Hsiung Wu
  • , Yao-Chou Tsai
  • , Zheng-Wei Chen
  • , Chien-Ting Pan
  • , Che-Wei Liao
  • , Cheng-Hsuan Tsai
  • , Yi-Yao Chang
  • , Chen-Hsun Ho
  • , Wei-Chieh Huang
  •  & Ying-Ying Chen

Contributions

JSC and VCW conceptualized and design the study; YHL, KHH, and VCW were responsible for investigation; CFL, YHL, and VCW were responsible for data curation; CFL and VCW were responsible for methodology; CFL and VCW were responsible for formal analysis; CFL and VCW were responsible for visualization; JSC was responsible for resources; JSC provided supervision; CFL and VCW wrote the original draft; and YHL, KHH, and JSC reviewed and edited the manuscript.

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Correspondence to Vin-Cent Wu.

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Lai, CF., Lin, YH., Huang, KH. et al. Kidney function predicts new-onset cardiorenal events and mortality in primary aldosteronism: approach of the 2021 race-free eGFR equation. Hypertens Res 47, 233–244 (2024). https://doi.org/10.1038/s41440-023-01400-0

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