| Objective:Primary aldosteronism(PA)is one of the most common causes of secondary hypertension,accounting for 5.9% of patients with hypertension.Compared with essential hypertension,the frequency of renal and cardiovascular complications in PA patients was higher than that in essential hypertension patients.Mineralocorticoid receptor antagonist(MRA)or adrenalectomy is the recommended treatment for PA.when blood pressure is normalized,it will also cause renal function damage.The latest research shows that adrenalectomy may be better than MRA in the prevention of PA kidney disease.However,normalization of blood pressure is not the only goal in the treatment of PA,and the complications of renal insufficiency must be effectively prevented.In this study,we aimed to identify the risk factors of chronic renal insufficiency(CKI)after primary aldosteronism surgery,and provide help for the prevention of postoperative chronic renal dysfunction,so as to avoid the occurrence of chronic renal insufficiency as far as possible,so as to reduce the health and economic loss of patients and society.Methods:In this study,a retrospective study was conducted to collect the clinical data of103 patients with primary aldosteronism who underwent adrenalectomy in Shanxi Bethune hospital from August 2018 to August 2019,including gender,age,body mass index(BMI),diabetes history,tumor maximum diameter,preoperative glomerular filtration rate(GFR),preoperative blood potassium,preoperative systolic blood pressure,preoperative plasma aldosterone concentration(PAC),preoperative aldosterone-renin ratio(ARR),operation time and intraoperative blood loss were recorded.GFR was recorded at 3 months after operation.SPSS 22.0 software was used for statistical analysis.The mean ± standard deviation was used to describe the measurement data.Paired sample t test was used to compare GFR before and after operation.Patients were divided into GFR≤60ml/(min·1.73m~2)group and GFR >60ml/(min · 1.73m~2)group.Pearson correlation coefficient analysis was used to evaluate the correlation between the factors and postoperative GFR.Univariate and multivariate logistic regression analysis was used to analyze the independent predictors of postoperative chronic renal failure.P<0.05 was considered statistically significant.Results:1.A total of 103 PA patients were included in this study.All of them underwent retroperitoneal laparoscopic adrenalectomy.The operation time was(85.37 ± 21.66)min,and the intraoperative blood loss was(10.54 ± 4.84)ml.At the third month after operation,the glomerular filtration rate was(62.66 ± 8.53)ml/(min · 1.73m~2),which was significantly lower than that before operation(P<0.01).After operation,the serum potassium was(3.85 ± 0.49)mmol/l,and the systolic blood pressure(133.25 ±12.61)mm Hg,PAC(22.8 ± 8.59)ng/dl and ARR(34.17 ± 9.46)were significantly lower than those before operation(P<0.01).2.There were 49 cases(48%)with GFR≤60ml/(min·1.73m~2).Patients were divided into GFR≤60ml/(min·1.73m~2)group and GFR>60ml/(min·1.73m~2)group.Among the two groups,(1)there were 25 males(51%)and 24 females(49%)in GFR≤60ml/(min·1.73m~2)group,and there were 28 males(52%)and 26 females(48%)in GFR>60ml/(min·1.73m~2)group,with no significant difference(P=0.93);(2)the average age of GFR≤60ml/(min·1.73m~2)group was 50.94±9.47 years old,and that of GFR > 60ml/(min·1.73m~2)was 43.46 ±9.23 years old,the difference was statistically significant(P<0.01);(3)the average BMI of GFR≤60ml/(min·1.73m~2)group was 24.41±3.34(kg/m~2),and that of GFR>60ml/(min·1.73m~2)group was 24.51±3.14(kg/m~2),the difference was not statistically significant(P=0.87);(4)there were 12 cases(24%)had diabetes history and 37 cases(76%)had no history of diabetes in GFR≤60ml/(min·1.73m~2)group,and there were 15 cases(28%)had history of diabetes and 39 cases(72%)had no history of diabetes in GFR>60ml/(min·1.73m~2)group,with no significant difference(P=0.71);(5)the maximum diameter of the tumor in the GFR≤60ml/(min·1.73m~2)group was 15.44±5.98 mm,and that of the GFR>60ml/(min·1.73m~2)group was 15.77±5.35 mm,the difference was not statistically significant(P=0.77);(6)the operation time of GFR≤60ml/(min·1.73m~2)group was 85.71±24.20 min,and that of GFR>60ml/(min·1.73m~2)group was 85.06± 19.05 min,the difference was not statistically significant(P=0.88);(7)the intraoperative blood loss in the GFR≤60ml/(min·1.73m~2)group was 10.55±5.13 ml,and that of the GFR>60ml/(min·1.73m~2)group was 10.53±4.56 ml,the difference was not statistically significant(P=0.99);(8)The preoperative systolic blood pressure of the GFR≤60ml/(min·1.73m~2)group was 167.61±12.15 mm Hg,and that of the GFR>60ml/(min·1.73m~2)group was 166.31±12.24 mm Hg,the difference was not statistically significant(P=0.59);(9)the preoperative serum potassium of the GFR≤60ml/(min·1.73m~2)group was 3.21±0.43 mmol/l,and that of the GFR>60ml/(min·1.73m~2)group was 3.48 ± 0.49 mmol/l,the difference was statistically significant(P<0.01);(10)the preoperative GFR of GFR≤60ml/(min·1.73m~2)group was 74.73±14.24 ml/(min·1.73m~2),and that of the GFR>60ml/(min·1.73m~2)group was 80.89±14.63 ml/(min· 1.73m~2),the difference was statistically significant(P=0.04);○11the preoperative PAC of GFR≤60ml/(min·1.73m~2)group was 58.06±8.43 ng/dl,and that of GFR>60ml/(min·1.73m~2)group was 58.06±8.43 ng/dl,the difference is statistically significant(P=0.01);○12 preoperative ARR of GFR≤60ml/(min·1.73m~2)group was 181.14±36.72,and that of GFR>60ml/(min·1.73m~2)group was 150.59±33.42,the difference was statistically significant(P<0.01).3.SPSS 22.0 software was used for statistical analysis.Univariate and multivariate logistic regression were used to analyze the independent predictors of GFR ≤ 60ml/(min · 1.73m~2)at 3 months after operation.Pearson correlation coefficient analysis was used to evaluate the correlation between the factors and postoperative GFR.In univariate analysis,age(OR=1.36,P<0.01),preoperative GFR(OR=0.81,P<0.01),preoperative serum potassium(OR=2.95,P=0.02),preoperative PAC(OR=1.28,P<0.01),preoperative ARR(OR=1.08,P<0.01),preoperative GFR(OR=0.81,P<0.01)were correlated with postoperative CKI,however,the history of diabetes,gender,body mass index,tumor size,operation time,intraoperative blood loss and preoperative systolic blood pressure were not correlated with postoperative CKI.Pearson correlation coefficient analysis showed that older age(r=-0.51,P<0.01),lower preoperative GFR(r=0.62,P<0.01),lower preoperative serum potassium(r=0.41,P=0.02),higher preoperative PAC(r=-0.49,P<0.01),and higher preoperative ARR(r=-0.56,P<0.01)were more likely to occur postoperative GFR reduction.Multivariate analysis showed that age(OR=1.26,P=0.05),preoperative GFR(OR=0.79,P=0.02)and preoperative PAC(OR=1.29,P=0.01)were independent predictors of postoperative CKI.Conclusion:CKI may occur in PA patients after adrenalectomy.PA patients with older age,higher preoperative PAC,higher preoperative ARR,lower preoperative blood potassium and lower preoperative GFR are more likely to have CKI.Age,preoperative GFR and preoperative PAC were independent predictors of CKI. |
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