Changes in kidney function after adrenalectomy in patients with primary aldosteronism

Objectives: A decrease in the estimated glomerular filtration rate (eGFR) is occasionally observed in patients with primary aldosteronism (PA) after adrenalectomy. Patients may misunderstand that the surgical stress of adrenalectomy can result in kidney dysfunction. However, this finding is consid...

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Main Authors: Yumi Tomiie, Yatsuka Hibi, Rie Nobe, Keito Yokoi, Yusuke Koshima, Kimio Ogawa, Tsuneo Imai, Zenichi Morise
Format: Article
Language:English
Published: Fujita Medical Society 2025-02-01
Series:Fujita Medical Journal
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Online Access:https://www.jstage.jst.go.jp/article/fmj/11/1/11_2024-011/_pdf/-char/ja
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author Yumi Tomiie
Yatsuka Hibi
Rie Nobe
Keito Yokoi
Yusuke Koshima
Kimio Ogawa
Tsuneo Imai
Zenichi Morise
author_facet Yumi Tomiie
Yatsuka Hibi
Rie Nobe
Keito Yokoi
Yusuke Koshima
Kimio Ogawa
Tsuneo Imai
Zenichi Morise
author_sort Yumi Tomiie
collection DOAJ
description Objectives: A decrease in the estimated glomerular filtration rate (eGFR) is occasionally observed in patients with primary aldosteronism (PA) after adrenalectomy. Patients may misunderstand that the surgical stress of adrenalectomy can result in kidney dysfunction. However, this finding is considered due to postoperative manifestations of kidney dysfunction that are masked preoperatively by excess aldosterone. To evaluate kidney dysfunction unmasked by adrenalectomy, we investigated changes in the eGFR after adrenalectomy according to the clinically assessable indication of “a certain drop in eGFR” as defined by the 2012 Kidney Disease Improving Global Outcomes clinical practice guideline. Methods: This study included 54 patients with PA who underwent unilateral adrenalectomy between 2005 and 2022 at our institution. We classified patients by GFR categories defined by the guideline according to their pre- and postoperative eGFR. We analyzed the predictors associated with a certain drop in eGFR (i.e., a decrease in GFR category accompanied by a ≥25% decrease in the eGFR from baseline). Results: A certain drop in eGFR was present in 35.2% of patients after adrenalectomy. Multivariate regression analysis showed that a longer duration of hypertension, lower preoperative serum potassium concentrations, and lower serum potassium concentrations before potassium supplementation were significant independent predictors (p<0.05). The cut-off value of the preoperative serum potassium concentrations was 3.7 mmol/L according to receiver operating characteristic curve analysis. Conclusions: Our findings will be useful for surgeons in informing patients with PA regarding the possibility of downgrading GFR categories after adrenalectomy.
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spelling doaj-art-ca19ecde076346dca9373e8a145777cc2025-02-04T06:35:53ZengFujita Medical SocietyFujita Medical Journal2189-72472189-72552025-02-01111283510.20407/fmj.2024-011Changes in kidney function after adrenalectomy in patients with primary aldosteronismYumi Tomiie0Yatsuka Hibi1Rie Nobe2Keito Yokoi3Yusuke Koshima4Kimio Ogawa5Tsuneo Imai6Zenichi Morise7Department of Endocrine Surgery, Fujita Health University, School of MedicineDepartment of Endocrine Surgery, Fujita Health University, School of MedicineDepartment of Endocrine Surgery, Fujita Health University, School of Medicine; Department of Nurse Practitioner, Fujita Health University HospitalDepartment of Endocrine Surgery, Fujita Health University, School of MedicineDepartment of Endocrine Surgery, Fujita Health University, School of MedicineDepartment of Endocrine Surgery, Fujita Health University, School of MedicineDepartment of Endocrine Surgery, Fujita Health University, School of MedicineDepartment of Surgery, Fujita Health University, School of MedicineObjectives: A decrease in the estimated glomerular filtration rate (eGFR) is occasionally observed in patients with primary aldosteronism (PA) after adrenalectomy. Patients may misunderstand that the surgical stress of adrenalectomy can result in kidney dysfunction. However, this finding is considered due to postoperative manifestations of kidney dysfunction that are masked preoperatively by excess aldosterone. To evaluate kidney dysfunction unmasked by adrenalectomy, we investigated changes in the eGFR after adrenalectomy according to the clinically assessable indication of “a certain drop in eGFR” as defined by the 2012 Kidney Disease Improving Global Outcomes clinical practice guideline. Methods: This study included 54 patients with PA who underwent unilateral adrenalectomy between 2005 and 2022 at our institution. We classified patients by GFR categories defined by the guideline according to their pre- and postoperative eGFR. We analyzed the predictors associated with a certain drop in eGFR (i.e., a decrease in GFR category accompanied by a ≥25% decrease in the eGFR from baseline). Results: A certain drop in eGFR was present in 35.2% of patients after adrenalectomy. Multivariate regression analysis showed that a longer duration of hypertension, lower preoperative serum potassium concentrations, and lower serum potassium concentrations before potassium supplementation were significant independent predictors (p<0.05). The cut-off value of the preoperative serum potassium concentrations was 3.7 mmol/L according to receiver operating characteristic curve analysis. Conclusions: Our findings will be useful for surgeons in informing patients with PA regarding the possibility of downgrading GFR categories after adrenalectomy.https://www.jstage.jst.go.jp/article/fmj/11/1/11_2024-011/_pdf/-char/japrimary aldosteronismadrenalectomyestimated glomerular filtration ratekidney dysfunctionhypokalemia
spellingShingle Yumi Tomiie
Yatsuka Hibi
Rie Nobe
Keito Yokoi
Yusuke Koshima
Kimio Ogawa
Tsuneo Imai
Zenichi Morise
Changes in kidney function after adrenalectomy in patients with primary aldosteronism
Fujita Medical Journal
primary aldosteronism
adrenalectomy
estimated glomerular filtration rate
kidney dysfunction
hypokalemia
title Changes in kidney function after adrenalectomy in patients with primary aldosteronism
title_full Changes in kidney function after adrenalectomy in patients with primary aldosteronism
title_fullStr Changes in kidney function after adrenalectomy in patients with primary aldosteronism
title_full_unstemmed Changes in kidney function after adrenalectomy in patients with primary aldosteronism
title_short Changes in kidney function after adrenalectomy in patients with primary aldosteronism
title_sort changes in kidney function after adrenalectomy in patients with primary aldosteronism
topic primary aldosteronism
adrenalectomy
estimated glomerular filtration rate
kidney dysfunction
hypokalemia
url https://www.jstage.jst.go.jp/article/fmj/11/1/11_2024-011/_pdf/-char/ja
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