Aldosterone correlates with increased risk of CKD progression, ESKD
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Aldosterone is associated with an increased risk of chronic kidney disease progression and the development of end-stage kidney disease, according to data published in the European Heart Journal.
Further, this correlation is independent of whether a patient has diabetes.
“Recent randomized, controlled trials have shown that a drug called finerenone is effective in delaying CKD progression and adverse cardiovascular outcomes in patients with chronic kidney disease and diabetes. However, the role of aldosterone in this process was not directly investigated and levels of the hormone were not measured,” Ashish Verma, MD, assistant professor at Boston University School of Medicine, said in the press release. He added, “Since excessive levels of aldosterone is common, yet mostly unrecognized, we hypothesized that one reason why finerenone was effective in lowering the risk of CKD progression was that it was treating unrecognized high concentrations of the hormone.”
Researchers investigated 3,680 patients from the Chronic Renal Insufficiency Cohort study with CKD to determine the link between serum aldosterone and kidney disease. Serum aldosterone measurements were taken at baseline, and no patients were using aldosterone antagonists.
For a median of almost 10 years, patients were followed annually at clinic visits and via telephone every 6 months. Using Cox proportional hazard models, researchers measured the relationship between serum aldosterone concentrations and kidney disease.
Researchers identified CKD progression in 38% of patients by the study conclusion. Adjusted models revealed each doubling of serum aldosterone correlated with an 11% increased risk of CKD progression. Compared with those in the lowest quartile of serum aldosterone, those with the highest quartile had a 45% increased risk of CKD progression.
“These findings are important as they suggest that higher concentrations of aldosterone may play a role in CKD progression and cardiovascular disease in patients with CKD,” Verma said in the press release. “This study provides evidence for the mechanism by which mineralocorticoid receptor antagonists could delay CKD progression and supports investigating their value in patients without diabetes.”
In an accompanying editorial, George L. Bakris, MD, a professor of medicine and the director of the American Heart Association-accredited Comprehensive Hypertension Center, University of Chicago Medicine, and Frederic Jaisser, MD, PhD, director of research at the French National Institute of Health and Medical Research, delved into the research.
“Given the time range and number of people assessed, this critical study further contributes to our knowledge base. Of note, however, while plasma aldosterone is adequate to measure the level of this hormone, it should be in the context of plasma renin activity to fully assess activation of the axis. Moreover, due to increased platelet adherence of aldosterone, 24-hour urine aldosterone corrected for creatinine is a more accurate way to determine aldosterone levels,” Bakris and Jaisser wrote. They added, “We now have relatively safe and better-tolerated agents than traditional steroidal agents that can and should be used to reduce cardiorenal risk in these groups of patients.”
References:
Aldosterone excess and cardiorenal risk: more common than appreciated. https://www.eurekalert.org/news-releases/960914? Published: Aug. 8, 2022. Accessed: Aug. 8, 2022.
Aldosterone linked to increased risk of chronic kidney disease progression and end-stage kidney disease. https://dx.doi.org/10.1093/eurheartj/ehac410. Published: Aug. 8, 2022. Accessed: Aug. 8, 2022.
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