scholarly journals Sex Differences in Renal Outcomes After Medical Treatment for Bilateral Primary Aldosteronism

Hypertension ◽  
2020 ◽  
Author(s):  
Ryo Nakamaru ◽  
Koichi Yamamoto ◽  
Hiroshi Akasaka ◽  
Hiromi Rakugi ◽  
Isao Kurihara ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Receptor Antagonist ◽  
Primary Aldosteronism ◽  
Mineralocorticoid Receptor ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Late Phase ◽  
Mineralocorticoid Receptor Antagonist ◽  
Renal Outcomes ◽  
Annual Decline

A higher incidence of bilateral primary aldosteronism in women is reported. Treatment of bilateral primary aldosteronism usually involves mineralocorticoid receptor antagonists. However, the impact of sex on renal outcomes is unknown. We compared renal outcomes between the sexes after mineralocorticoid receptor antagonist initiation by analyzing data obtained from 415 female and 313 male patients with bilateral primary aldosteronism who were treated with spironolactone or eplerenone in the JPAS (Japan Primary Aldosteronism Study). Over the course of 5 years, the temporal reduction in the estimated glomerular filtration rate was greater in women than in men ( P <0.001). Systolic blood pressure levels were equal between the sexes, despite higher doses of antihypertensive drugs in men. The mean of the annual decline in estimated glomerular filtration rate during what we termed the late phase, or 6 to 60 months after mineralocorticoid receptor antagonist initiation, was larger in women than in men after adjusting for patient characteristics (−1.33 mL/min per 1.73 m 2 per year versus −1.04 mL/min per 1.73 m 2 per year, P <0.01). Female sex was a significant predictor of greater annual decline during the late phase in patients taking spironolactone but not in those taking eplerenone. Spironolactone use and diabetes were independent predictors of a greater annual decline in estimated glomerular filtration rate during the late phase in women. These findings suggest that female sex is associated with poorer renal outcomes in patients receiving mineralocorticoid receptor antagonist for bilateral primary aldosteronism.

scholarly journals Mineralocorticoid Receptor Antagonists for Hypertension Management in Advanced Chronic Kidney Disease

Hypertension ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 144-149 ◽  
Author(s):  
George Bakris ◽  
Y. Fred Yang ◽  
Bertram Pitt
Keyword(s):  
Blood Pressure ◽  
Glomerular Filtration Rate ◽  
Systolic Blood Pressure ◽  
Glomerular Filtration ◽  
Mineralocorticoid Receptor ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Uncontrolled Hypertension ◽  
Mineralocorticoid Receptor Antagonist ◽  
Increased Risk

Spironolactone, a steroidal mineralocorticoid receptor antagonist, is recommended as add-on therapy for treatment-resistant/uncontrolled hypertension. However, caution is advised in patients with advanced chronic kidney disease (CKD) due to an increased risk for hyperkalemia. KBP-5074 is a nonsteroidal mineralocorticoid receptor antagonist under investigation for the treatment of treatment-resistant and uncontrolled hypertension in patients with moderate-to-severe CKD. BLOCK-CKD is a phase 2, international, multicenter, randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of KBP-5074, on top of current therapy, in patients with stage 3B/4 CKD (estimated glomerular filtration rate ≥15 and ≤44 mL/[min·1.73 m 2 ]) and resistant hypertension (trough cuff seated systolic blood pressure ≥140 mm Hg, despite treatment with maximally tolerated doses of 2 or more antihypertensive medicines with complementary mechanisms). Patients (n=240) will be randomized 1:1:1 to once-daily treatment with KBP-5074 0.25 mg, KBP-5074 0.5 mg, or placebo, stratified by estimated glomerular filtration rate (≥30 versus <30 mL/[min·1.73 m 2 ]) and systolic blood pressure (≥160 versus <160 mm Hg). Approximately 30% of enrolled patients should have an estimated glomerular filtration rate of 15 to 29 mL/(min·1.73 m 2 ). The primary efficacy analysis is the change in trough cuff seated systolic blood pressure from baseline to day 84 for the KBP-5074 doses compared with placebo. Changes in urinary albumin-creatinine ratio will be assessed along with changes in serum potassium/incidence of hyperkalemia and changes in estimated glomerular filtration rate and serum creatinine. BLOCK-CKD will determine whether the addition of KBP-5074 will effectively lower blood pressure without an increased risk of hyperkalemia in patients who are not candidates for steroidal mineralocorticoid receptor antagonists due to advanced CKD. Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT 03574363.

scholarly journals Cardiovascular and Renal Outcomes of Mineralocorticoid Receptor Antagonist Use in PARAGON-HF

2021 ◽  
Vol 9 (1) ◽  
pp. 13-24
Author(s):  
Karola S. Jering ◽  
Faiez Zannad ◽  
Brian Claggett ◽  
Finnian R. Mc Causland ◽  
João Pedro Ferreira ◽  
...  
Keyword(s):  
Receptor Antagonist ◽  
Mineralocorticoid Receptor ◽  
Mineralocorticoid Receptor Antagonist ◽  
Renal Outcomes

U-shaped relationship between left ventricular mass index and estimated glomerular filtration rate in patients with primary aldosteronism

2019 ◽  
Vol 68 (2) ◽  
pp. 371-377
Author(s):  
Min-Tsun Liao ◽  
Che-Wei Liao ◽  
Cheng-Hsuan Tsai ◽  
Yi-Yao Chang ◽  
Zheng-Wei Chen ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Left Ventricular Mass ◽  
Primary Aldosteronism ◽  
Filtration Rate ◽  
Left Ventricular Mass Index ◽  
Estimated Glomerular Filtration Rate ◽  
Left Ventricular ◽  
Ventricular Mass Index ◽  
Ventricular Mass

Estimated glomerular filtration rate (eGFR) is an important topic in patients with primary aldosteronism (PA). However, the relationship between left ventricular structure and eGFR is unclear. We conducted a prospective, observational, and cross-sectional study to analyze 168 patients with PA and 168 propensity score-matched patients with essential hypertension (EH) as the control group, matched by age, gender, and systolic blood pressure. In the patients with PA, the eGFR was not correlated with left ventricular mass index (LVMI; r=−0.065, p=0.404), while in the patients with EH, the eGFR was negatively correlated with LVMI (r=−0.309, p<0.001). To test whether eGFR had a non-linear relationship with LVMI among the patients with PA, we stratified the patients with PA according to the tertile of eGFR (low, medium, and high tertile). The medium tertile of patients had a significantly lower LVMI than those in the other two tertiles (LVMI: 143.5±41.6, 120.5±40.5, and 133.1±34.3 g/m2, from the lowest to highest tertile of eGFR; analysis of covariance p=0.032). The medium tertile of eGFR is associated with lowest LVMI. Patients with PA with high and low eGFR were associated with higher LVMI. The findings implied that the reasons for an increased LVMI in patients with PA may be different to those in patients with EH.

Annual decline in estimated glomerular filtration rate is a risk factor for cardiovascular events independent of proteinuria

Nephrology ◽  
2014 ◽  
Vol 19 (9) ◽  
pp. 574-580 ◽  
Author(s):  
Kei Nagai ◽  
Kunihiro Yamagata ◽  
Reiko Ohkubo ◽  
Chie Saito ◽  
Koichi Asahi ◽  
...  
Keyword(s):  
Risk Factor ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Cardiovascular Events ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Annual Decline
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