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  • 1
    Online Resource
    Online Resource
    Transtubular potassium gradient predicts kidney function impairment after adrenalectomy in primary aldosteronism
    SAGE Publications ; 2020
    In:  Therapeutic Advances in Chronic Disease Vol. 11 ( 2020-01), p. 204062232094479-
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    In: Therapeutic Advances in Chronic Disease, SAGE Publications, Vol. 11 ( 2020-01), p. 204062232094479-
    Abstract: In primary aldosteronism (PA), kidney function impairment could be concealed by relative hyperfiltration and emerge after adrenalectomy. We hypothesized transtubular gradient potassium gradient (TTKG), a kidney aldosterone bioactivity indicator, could correlate to end organ damage and forecast kidney function impairment after adrenalectomy. Methods: In the present prospective study, we enrolled lateralized PA patients who underwent adrenalectomy and were followed up 12 months after operation in the Taiwan Primary Aldosteronism Investigation (TAIPAI) registry from 2010 to 2018. The clinical outcome was kidney function impairment, defined as estimated glomerular filtration rate (eGFR) 〈 60 ml/min/1.73 m 2 at 12 months after adrenalectomy. End organ damage is determined by microalbuminuria and left ventricular mass. Results: In total, 323 patients [mean, 50.8 ± 10.9 years old; female 178 (55.1%)] were enrolled. Comparing pre-operation and post-operation data, systolic blood pressure, serum aldosterone, urinary albumin to creatinine ratio and eGFR decreased. TTKG ⩾ 4.9 correlated with pre-operative urinary albumin to creatinine ratio 〉 50 mg/g [odds ratio (OR) = 2.42; p = 0.034] and left ventricular mass (B = 20.10; p = 0.018). Multivariate logistic regression analysis demonstrated that TTKG ⩾ 4.9 could predict concealed chronic kidney disease (OR = 5.42; p = 0.011) and clinical success (OR = 2.90, p = 0.017) at 12 months after adrenalectomy. Conclusions: TTKG could predict concealed kidney function impairment and cure of hypertension in PA patients after adrenalectomy. TTKG more than 4.9 as an adverse surrogate of aldosterone and hypokalaemia correlated with pre-operative end organ damage in terms of high proteinuria and cardiac hypertrophy.
    Type of Medium: Online Resource
    ISSN: 2040-6223 , 2040-6231
    URL: Article
    DOI: 10.1177/2040622320944792
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 2
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    The Relation among Aldosterone, Galectin-3, and Myocardial Fibrosis: A Prospective Clinical Pilot Follow-Up Study
    SAGE Publications ; 2016
    In:  Journal of Investigative Medicine Vol. 64, No. 6 ( 2016-08), p. 1109-1113
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    In: Journal of Investigative Medicine, SAGE Publications, Vol. 64, No. 6 ( 2016-08), p. 1109-1113
    Abstract: Primary aldosteronism has been associated with myocardial fibrosis, and is the most common cause of secondary hypertension. We previously showed that aldosterone can induce the secretion of galectin-3. The aim of this study was to investigate the association between myocardial fibrosis and plasma galectin-3 level in patients with primary aldosteronism. We prospectively analyzed 11 patients with aldosterone-producing adenoma (APA) who received adrenalectomy from December 2006 to October 2008, and 17 patients with essential hypertension as controls. Levels of plasma galectin-3 were determined in both groups, and both groups underwent echocardiography with cyclic variations of integrated backscatter (CVIBS) to characterize tissue initially and 1 year after surgery in the APA group. Diastolic blood pressure, concentration of plasma aldosterone and aldosterone-renin ratio were significantly higher, and serum potassium level and plasma renin activity significantly lower in the APA group compared to the controls. In addition, left ventricular mass index was significantly higher and CVIBS significantly lower in the APA group (7.3±2.0 vs 9.2±1.7 dB, p=0.015). Furthermore, the concentration of plasma galectin-3 was significantly higher in the APA group (2.1±0.9 vs 1.1±0.6 ng/mL, p=0.005) compared to the controls. CVIBS was correlated to plasma galectin-3 level. In the APA group, CVIBS increased significantly (7.3±2.0 to 9.2±2.4 dB, p=0.032) and plasma galectin-3 decreased (2.1±0.9 to 1.2±0.6, p=0.049) 1 year postadrenalectomy. The patients with APA had increased myocardial fibrosis, and this was associated with a higher plasma galectin-3 level. Both increased myocardial fibrosis and plasma galectin-3 level recovered at least partially after adrenalectomy. Trial registration number 200611031R; Results.
    Type of Medium: Online Resource
    ISSN: 1081-5589 , 1708-8267
    URL: Article
    DOI: 10.1136/jim-2015-000014
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 3
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    The Relation between the Degree of Left Ventricular Mass Regression and Serum Potassium Level Change in Patients with Primary Aldosteronism after Adrenalectomy
    SAGE Publications ; 2015
    In:  Journal of Investigative Medicine Vol. 63, No. 6 ( 2015-08), p. 816-820
    Details
    In: Journal of Investigative Medicine, SAGE Publications, Vol. 63, No. 6 ( 2015-08), p. 816-820
    Abstract: Primary aldosteronism (PA) is one of the major etiologies for secondary hypertension featuring more prominent left ventricular hypertrophy. The purpose of the study was to investigate the predictive factors of left ventricular mass index (LVMI) regression in patients with PA after adrenalectomy. Methods We prospectively analyzed 30 patients with aldosterone-producing adenoma (APA) who received adrenalectomy from October 2006 to September 2008. Echocardiography was performed preoperation and 1 year after operation. Results Thirty patients with aldosterone-producing adenoma undergoing adrenalectomy were enrolled. In a 1-year follow-up, LVMI decreased significantly by an average of 18.6%. Net LVMI decrease (ΔLVMI) was associated with preoperative LVMI, preoperative serum potassium level, baseline systolic blood pressure (SBP), baseline diastolic blood pressure, net SBP decrease (ΔSBP), net diastolic blood pressure decrease, preoperative/postoperative change of log-transformed plasma aldosterone concentration, preoperative/postoperative change of log-transformed plasma renin activity, and preoperative/postoperative change of serum potassium level (Δserum potassium level). In a multiple regression analysis, preoperative LVMI (β = −0.287, P = 0.049), ΔSBP (β = 0.518, P = 0.01), and Δserum potassium level (β = −20.471, P = 0.014) were significantly correlated with ΔLVMI. Conclusions The LVMI in patients with PA regressed significantly after adrenalectomy. Preoperative LVMI, ΔSBP, and Δserum potassium levels are independent factors associated with the degree of LVMI regression.
    Type of Medium: Online Resource
    ISSN: 1081-5589 , 1708-8267
    URL: Article
    DOI: 10.1097/JIM.0000000000000215
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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