Kidney Week

Abstract: SA-PO537

Kidney Function Predicts New-Onset Cardiorenal Events and Mortality in Primary Aldosteronism: Approach of the 2021 Race-Free eGFR Equation

Session Information

• Hypertension and CVD: Clinical - II
  November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Lai, Chun-Fu, National Taiwan University Hospital, Taipei, Taiwan

Chun-Fu Lai,

• Lin, Yen-Hung, National Taiwan University Hospital, Taipei, Taiwan

Yen-Hung Lin,

• Wu, Vincent, National Taiwan University Hospital, Taipei, Taiwan

Vincent Wu,

Group or Team Name

• Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group.

Background

Individuals with primary aldosteronism (PA) exhibit glomerular hyperfiltration, which may conceal underlying kidney damage. We aimed to investigate whether baseline estimated glomerular filtration rate (eGFR) is associated with cardiovascular outcomes in this population.

Methods

This observational cohort study enrolled 760 coronary artery disease-naïve patients diagnosed with PA between January 1, 2007 and December 31, 2018 (male, 45%; mean age, 52.3 ± 11.9 years). The baseline 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. Outcomes were composite cardiovascular events (total death, non-fatal myocardial infarction, and coronary revascularization procedure), all-cause mortality, and adverse kidney events.

Results

During a mean follow-up of 5.8 ± 3.2 years, new-onset composite cardiovascular events occurred in 47 patients, with 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/1.73m². Patients with baseline eGFR <85 mL/min/1.73m² were independently associated with higher risks of composite cardiovascular events (HR, 2.39 [95% CI, 1.16–4.93]), 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). (Figure 1A-C)

Conclusion

Our data support interpreting 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 point to the validity of the 2021 race-free CKD-EPI equation in patents with PA.

Figure 1. Clinical outcomes of interest in patients stratified by the baseline kidney function.

Funding

• Government Support – Non-U.S.