Predictors of eGFR Decline Following Treatment for Primary Aldosteronism
DOI:
https://doi.org/10.64945/ts9pr242Keywords:
Primary Aldosteronism, Adrenalectomy, mineralocorticoid receptor antagonists, Chronic kidney diseaseAbstract
Introduction
Primary aldosteronism (PA) is the most common cause of secondary hypertension and is associated with significant cardiovascular and renal morbidity. Treatment with mineralocorticoid receptor antagonists (MRA) or adrenalectomy often leads to an early decline in estimated glomerular filtration rate (eGFR), which may be misinterpreted as renal injury rather than the correction of aldosterone-induced hyperfiltration. This study aimed to evaluate renal function changes following PA treatment and to identify predictors of eGFR decline.
Methods
A retrospective cohort study was conducted involving patients with confirmed or probable PA who attended a tertiary endocrine hypertension clinic between July 2016 and June 2023. Clinical and biochemical parameters were collected at baseline and at follow-up clinic visits after treatment. Patients were grouped according to treatment modality (MRA or adrenalectomy). Longitudinal changes in eGFR and urine albumin-to-creatinine ratio (ACR) were analysed, and multivariable regression was performed to identify independent predictors of eGFR decline.
Results
Of 421 patients, 339 (81%) received MRA therapy and 82 (19%) underwent adrenalectomy. Both groups demonstrated a modest eGFR reduction at 12-24 months, with median declines of 4 mL/min/1.73 m² and 6 mL/min/1.73 m² respectively, followed by stabilisation at long-term follow-up. Albuminuria improved significantly in both groups, with median ACR decreasing from 1.7 to 1.0 mg/mmol in the MRA group and from 2.2 to 0.7 mg/mmol after adrenalectomy (p<0.05). Among medically treated patients, age and baseline eGFR were independent predictors of post-treatment decline, while no independent predictors were found in the surgical group.
Conclusion
Treatment of PA results in a transient eGFR decline that reflects haemodynamic recovery from hyperfiltration rather than progressive renal injury. Concurrent improvements in albuminuria confirm renal benefit. Recognition of this physiological adjustment is essential to prevent inappropriate therapy discontinuation.
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Copyright (c) 2026 Dr Karanjeet S. Chauhan, Senesha Kumarage, Prof Peter J. Fuller, Prof Peter G Kerr, Dr Jessica Ryan, Dr Fumiko Katsuragawa, A/Prof Jun Yang, Dr Renata Libianto (Author)
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