Kidney Week

Abstract: TH-PO219

National Rates of Primary Aldosteronism Screening in Patients with CKD

Session Information

• Hypertension and CVD: Clinical - I
  November 02, 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

• Cohen, Jordana B., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Jordana B. Cohen,

• Bonanni, Maria, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Maria Bonanni,

• Passman, Jesse, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Jesse Passman,

• Wachtel, Heather, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Heather Wachtel,

• Cohen, Debbie L., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Debbie L. Cohen,

Background

Primary aldosteronism (PA) is a common, treatable cause of resistant hypertension and kidney fibrosis but is vastly underdiagnosed. Limited evidence exists regarding screening rates and outcomes of screening for PA among patients with chronic kidney disease (CKD).

Methods

In a national cohort of US Veterans diagnosed with incident hypertension and followed from January 2000 to December 2021, we identified patients with new indications for PA screening (i.e., hypertension with hypokalemia or resistant hypertension). We evaluated rates of PA screening and results of screening among those with and without CKD (eGFR <60 vs. ≥60 mL/min/1.73m²) using Cox regression, adjusted for age, sex, race, systolic blood pressure, heart rate, insurance status, smoking, substance abuse, homelessness, cardiovascular disease, obstructive sleep apnea, and diabetes.

Results

A total of 457,395 patients met inclusion criteria, among whom 73,747 (16%) had CKD at the time of developing a new indication for PA screening. Those with CKD were older (mean 72 vs. 61 years) and had higher serum potassium levels (4.2 vs. 4.0 mEq/L) and higher prevalence of diabetes (42% vs. 30%) and cardiovascular disease (25% vs. 18%) compared to those without CKD. In the overall cohort, 7,427 (1.5%) patients underwent PA screening, among whom 1,068 (14%) had biochemical evidence of PA. Patients with CKD were 55% more likely to undergo PA screening than those without CKD (adjusted HR 1.55, 95% CI 1.44-1.67), which was similar across all CKD stages. Among those who underwent PA screening, biochemical evidence of PA was similar in patients with and without CKD (adjusted HR 0.92, 95% CI 0.75-1.12). Patients with CKD had similar rates of adrenalectomy but were less likely than those without CKD to be appropriately treated with a mineralocorticoid receptor antagonist (adjusted HR 0.86, 95% CI 0.78-0.94), excluding patients with serum potassium >4.5 mEq/L.

Conclusion

In a national cohort of Veterans with indications to undergo PA screening, those with CKD were more likely to undergo PA screening and had similar rates of PA compared to those without CKD, but were less likely to receive appropriate treatment with a mineralocorticoid receptor antagonist. Overall, rates of PA screening among all groups were exceptionally low.

Funding

• Other NIH Support