Electrolyte Blood Press.  2019 Dec;17(2):45-53. 10.5049/EBP.2019.17.2.45.

Incidence of Acute Kidney Injury after Adrenalectomy in Patients with Primary Aldosteronism

• Lee JY
• Kim H
• Kim HW
• Ryu GW
• Nam Y
• Lee S
• Joo YS
• Lee S
• Park JT
• Han SH
• Kang SW
• Yoo TH
• Yun HR

• KMID: 2467960
• DOI: http://doi.org/10.5049/EBP.2019.17.2.45

Abstract

BACKGROUND
Aldosterone-induced glomerular hyperfiltration can lead to masked preoperative renal dysfunction in primary aldosteronism(PA) patients. We evaluated whether PA patients had a higher prevalence of acute kidney injury (AKI) after unilateral adrenalectomy. In addition, we identified risk factors for AKI in these subjects.
METHODS
This retrospective study included 107 PA patients, and 186 pheochromocytoma patients as a control group, all of whom underwent adrenalectomy between January 2006 and November 2017 at Yonsei University Severance Hospital. The primary outcome was AKI within 48 hours after adrenalectomy. Univariate and multivariate logistic regression analyses were performed to identify predictors of AKI after adrenalectomy.
RESULTS
Overall incidence of AKI was 49/293 (16.7%). In PA patients, the incidence of AKI was 29/107 (27.1%). In contrast, incidence of AKI was 20/186 (10.7%) in pheochromocytoma patients. Univariate and multivariate logistic regression analysis both showed a higher risk of postoperative AKI in PA patients compared to pheochromocytoma patients. In addition, old age, diabetes, longer duration of hypertension, lower preoperative estimated glomerular filtration rate, high aldosterone-cortisol ratio (ACR) and lateralization index (LI) were identified as independent risk factors for postoperative AKI in PA patients after unilateral adrenalectomy.
CONCLUSION
Incidence and risk of postoperative AKI were significantly higher in PA patients after surgical treatment. High ACR on the tumor side and high LI were associated with higher risk of AKI in PA patients compared to pheochromocytoma patients.

Keyword

Primary aldosteronism; Adrenalectomy; Renal insufficiency; Pheochromocytoma

MeSH Terms

Acute Kidney Injury*
Adrenalectomy*
Glomerular Filtration Rate
Humans
Hyperaldosteronism*
Hypertension
Incidence*
Logistic Models
Masks
Pheochromocytoma
Prevalence
Renal Insufficiency
Retrospective Studies
Risk Factors

Figure

• 

  Fig. 1 Flow diagram of study design.

• 

  Fig. 2 Comparison of baseline and postoperative eGFR in PA and pheochromocytoma patients. Note: Baseline and postoperative eGFR were compared using the Student's t-test. (A) Primary aldosteronism, (B) Pheochromocytoma. *p-value=0.001. PA, primary aldosteronism; eGFR, estimated glomerular filtration rate.

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