부산대학교 도서관

OBJECTIVE:: In experimental animal models a significant association between exogenous aldosterone excess and the progression of renal disease has been observed. However, the evidence of an increased risk of renal damage in patients affected by primary aldosteronism (PA) remains controversial. We aimed to assess the relationship between PA, renal target organ damage and its reversibility, by synthesizing available evidence from prospective and retrospective observational studies, through a meta-analysis. DESIGN AND METHOD:: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from January 1960 up to August 2017. Forty-four studies including 4,438 patients with PA and 8,234 patients with non-PA arterial hypertension were eligible for this meta-analysis. In 14 out of 44 studies, patients with different degree of renal impairment were excluded and for analysis purpose two subgroups have been generated (i.e. “Renal disease excluded” and “Renal disease not excluded”). RESULTS:: After 8.5 years from the diagnosis of hypertension, the glomerular filtration rate (GFR) was significantly higher in the overall PA population (by 3.93 ml/min IQR [0.60; 7.26]). Of note, subgroup analysis indicated that the difference in GFR was significant only in those studies that included patients with renal disease (by 5.69 ml/min [1.15; 10.22]), while when considering the studies in which patients with renal disease were excluded, the mean GFR was not different between the two populations. Similarly, a more severe albuminuria (Std. mean difference 0.57 [0.11–1.03]), resulting into a significant association with microalbuminuria (OR 2.15 [1.21; 3.84]) was observed in patients affected by PA. Following specific PA treatment, after a median follow-up of 12 months, a significant reduction in GFR was observed (by −10.57 ml/min [−13.60; −7.55]) that was consistent in both surgically and medically treated patients. Consistently, a reduction in albumin excretion and an increase in serum creatinine were observed after specific treatment. CONCLUSIONS:: The results of the present meta-analysis further emphasize the importance of an early diagnosis of PA, since affected patients, compared with non-PA hypertensive patients, display a more pronounced renal organ damage, which can be at least partly reverted by the specific treatment.