| Background and objective:Primary aldosteronism(PA)is a common secondary hypertension.Compared with essential hypertension(EH),PA has more serious damage to target organs such as heart,brain and kidney,higher risk of caradverse events and more complications.Elevated aldosterone will not only cause increased blood pressure,but also affect the metabolism of blood glucose,blood lipids and electrolytes,and PA is easy to be combine with metabolic syndrome and electrolyte disorders.Kidney plays an important role in human metabolism.When kidney function declines,the excretion is reduced,which will also affect blood pressure,blood sugar,lipid and electrolyte metabolism.These metabolic abnormalities are risk factors for cardiovascular disease and kidney damage.Estimated glomerular filtration rate(eGFR)is an important indicator of renal function,while PA is characterized by high glomerular filtration rate.the actual renal status may be lower than that reflected by eGFR,ignoring early renal impairment.Therefore,the purpose of this study was to explore the clinical characteristics of different eGFR levels in patients with PA,analyze the effects of different renal function conditions on metabolism and blood pressure changes in patients with PA,timely identify and intervene related risk factors.Methods:A total of 441 patients diagnosed with primary aldosteronism admitted to the Second Hospital of Lanzhou University from January 1,2017 to August 30,2022 were enrolled according to the natrium standard.eGFR was calculated using Modification of Diet in Renal Disease(MDRD)in the Chinese population,reflecting the level of renal function.According to the value of eGFR was divided into eGFR≥90 ml/(min·1.73 m2)group(n=183),90 ml/(min·1.73 m2)>eGFR≥60 ml/(min·1.73 m2)group(n=186)and 60<eGFR ml/(min·1.73 m2)group(n=72),to analyze the clinical features of primary aldosteronism with different eGFR levels.General data such as age,sex,duration of hypertension,height,weight,body mass index(BMI),serum creatinine(Scr),serum aldosterone concentration(SAC)and plasma renin activity(PRA)were collected.Renal function indicators:urinary microalbumin(MAU),urinary β2 microsphere albumin(β2MGU),urinary creatinine(Ucr),urinary microalbumin/urinary creatinine(MAU/Ucr).Biochemical indicators:fasting blood glucose(FPG),total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL),low density lipoprotein(LDL).Electrolyte index:Serum sodium,potassiumion,magnesium,calcium,phosphorus,24-hour urine sodium,urine potassium,urine calcium,urine magnesium,urine phosphorus.24-hour ambulatory blood pressure parameters:daytime diastolic blood pressure(dSBP),daytime diastolic blood pressure(dDPB),night systolic blood pressure(nSBP),night diastolic blood pressure(nDBP),24 hours systolic blood pressure(24hSBP),24 hours diastolic blood pressure(24hDBP),daytime systolic blood pressure load,daytime diastolic blood pressure load,night systolic blood pressure load,night diastolic blood pressure load,24-hour diastolic blood pressure load,24-hour diastolic blood pressure load,coefficient of variation in daytime systolic blood pressure,coefficient of variation in daytime diastolic blood pressure,coefficient of variation in nighttime systolic blood pressure,coefficient of variation in nighttime diastolic blood pressure,coefficient of variation in 24-hour systolic blood pressure,coefficient of variation in 24-hour diastolic blood pressure,rate of decrease in blood pressure at night.Echocardiographic indicators:left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVEDs),ventricular septal thickness(IVST),ventricular wall thickness(LVPWT),left ventricular ejection fraction(EF%),peak mitral orifice flow velocity in early diastolic period(E),and late mitral orifice flow velocity in late diastolic period(A)as measured by thoracic echocardiography Peak(A),peak velocity of early mitral ring diastolic motion(e’),E/e’ and E/A,and left ventricular mass index were calculated.Results:1.The basic information and renal damage index comparison results:Pairwise comparison results show that 60≤eGFR<90 patients are older than 90≥eGFR group(52.3±10.2 years vs 45.7±11.2 years,P<0.05),eGFR<60 patients are older than eGFR≥90 group and 90>eGFR≥60 group(55.7±11.2 years 45.7±11.2 years,P<0.05)and(55.7±11.2 years vs 52.3±10.2 years,P<0.05);eGFR<60 patients’ duration is longer than eGFR≥90 and 90>eGFR≥60 group[10.1(1.1,15.3)years 4.2(1.3,9.0)years,P<0.05]and[10.1(1.1,15.3)years vs 5.3(2.2,10.1)years,P<0.05];In urine kidney function index,eGFR<60 group MAU and β2MGU and MAU/Ucr are higher than eGFR≥90 and 90>eGFR≥60 group[41.0(14.6,88.5)mg/L vs 10.5(5.3,25.8)mg/L,P<0.05]and[41.0(14.6,88.5)mg/L vs 7.3(3.2,19.6)mg/L,P<0.05],[480(335,571)ug/L vs 171(111,368)ug/L,P<0.05]and[480(335,571)ug/L vs 187(92,373)ug/L,P<0.05]and[7.6(2.0,17.3)mg/mmol vs 1.0(0.6,2.3)mg/mmol,P<0.05]and[7.6(2.0,17.3)mg/mmol vs 0.8(0.3,2.1)mg/mmol,P<0.05].In term of SAC,eGFR<60 patients are higher than eGFR≥90 and 90>eGFR≥60 group[30.6(22.4,43.4)ng/dL vs 20.9(16.4,26.7)ng/dL,P<0.05]and[30.6(22.4,43.4)ng/dL vs 20.1(16.9,28)ng/dL,P<0.05].Correlation analysis showed that age,disease course,MAU,β2MGU,MAU/Ucr and SAC were negatively correlated with eGFR(r=-0.342,r=-0.179,r=0.203,r=-0.146,r=-0.189,r=-0.235,P<0.05).2.Metabolic index comparison results:(1)eGFR<60 group has a higher FPG,elevated FPG and the incidence of diabetes than eGFR≥90 group(6.5±2.1 mmol/L vs 5.7±1.7 mmol/L,P<0.05),(44.4%vs 21.9%,P<0.05)and(41.7%vs 13.1%,P<0.05).Correlation analysis results show that the levels of FPG,elevated fasting glucose levels and the incidence of diabetes and eGFR negative correlation(r=0.135,r=0.152,r=0.126,P<0.05).(2)Comparison of electrolyte metabolism results:two comparison results show that 90>eGFR≥60 has higher incidence of low potassium than eGFR≥90 group(51.5%vs 37.7%,P<0.05).In 24 hours urinary calcium level and incidence of high urinary calcium,eGFR≥90 group is higher than eGFR<60 group[6.3(4.3,8.2)mmol/L vs 4.3(1.9,6.6)mmol/L,P<0.05]and(33.3%vs 12.5%,P<0.05).Electrolytes and eGFR correlation analysis results:24 hours urinary calcium and eGFR have positive correlation(r=0.253,r=0.154,P<0.05).(3)Blood pressure comparison results.In PA patients with different eGFR level,dSBP,dDPB,nSBP,nDBP,24hSBP,24hDBP,daytime systolic blood pressure load,daytime diastolic blood pressure load,night systolic blood pressure load,night diastolic blood pressure load,24 hours diastolic blood pressure load,24 hours diastolic blood pressure load,daytime systolic blood pressure variation coefficient,daytime diastolic blood pressure variation coefficient,night systolic blood pressure variation coefficient,night diastolic blood pressure variation coefficient,24 hours systolic blood pressure variation coefficient,24hours diastolic blood pressure variation coefficient and night blood pressure drop rate were no significant differences among groups(P>0.05).Different eGFR levels’ model of dynamic blood pressure ratio is no statistical difference between groups(P>0.05),but in between each group of nondipper type model is the most common blood pressure.The proportion of arytenoid decreased significantly with the decrease of eGFR.3.Comparative results of echocardiography related indexes:eGFR<60 group IVST,LVPWT,LVMI and incidence of left ventricular hypertrophy is higher than the eGFR≥90(1.14±0.15 cm vs 0.89±0.18 cm,P<0.05),(1.12±0.16 cm vs 0.91±0.15 cm,P<0.05),(99.96±28.16 g/m2 vs 80.42±22.70 g/m2,P<0.05)and(34.7%vs 13.1%,P<0.05).Echocardiography and eGFR correlation analysis showed that the I VST,LVPWT,LVMI and left ventricular hypertrophy and eGFR negative correlation(r=0.251,r=-0.171,r=-0.157,r=-0.136,P<0.05).4.The results of multi-factor linear regression analysis affecting eGFR.Age had a negative correlation with eGFR(b=-0.869,P<0.05)and SAC had a negative correlation with eGFR(b=-0.353,P<0.05).Conclusions:The obvious renal damage in PA patients was characterized by older age and high serum aldosterone level.PA patients with decreased eGFR are at higher risk for glycemic disorders,and decreased eGFR may contribute to PA-induced glycemic elevation.In terms of electrolyte metabolism,decreased eGFR significantly affected urinary calcium excretion and blood potassium levels,as decreased eGFR decreased urinary calcium excretion and blood potassium.In terms of blood pressure,there was no difference in early 24-hour ambulatory blood pressure parameters at different eGFR levels,and the phenotype of ambulatory blood pressure at all levels was dominated by non-arytenoid type.eGFR in patients with PA is associated with left ventricular structural changes,and patients with PA are at increased risk of cardiac remodeling with mild renal impairment. |
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