Journal of endocrinological investigation · 2025
Chronic kidney disease, hyperuricemia, and gout after adrenalectomy for primary aldosteronism: a 20-year population-based study.
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Fang Chu-Wen, Muo Chih-Hsin, Wu Shih-Chi
Аннотация
INTRODUCTION: Unilateral adrenalectomy is a definitive treatment for patients with primary aldosteronism (PA), yet its long-term renal and metabolic consequences remain insufficiently characterized. This study aimed to evaluate the incidence, risk, and cumulative burden of chronic kidney disease (CKD)/renal impairment, hyperuricemia, and gout in patients undergoing adrenalectomy compared to matched controls.
METHODS: We used the Longitudinal Generation Tracking Database (LGTD) from the Health and Welfare Data Science Center, Taiwan, which includes data from 2 million individuals insured since 2000. We identified 1,110 primary aldosteronism (PA) patients diagnosed between 2000 and 2019, excluding those with adrenal insufficiency or pre-existing hyperuricemia, gout, CKD, or plasma cell dyscrasia. The final cohort included 537 PA patients who underwent unilateral adrenalectomy, with a control group matched 4:1 using propensity scores based on age, gender, and comorbidities. Outcomes included new-onset CKD/renal impairment, hyperuricemia, and gout. Adjusted hazard ratios (aHRs) were estimated using Cox proportional hazards models, and cumulative incidence was visualized via Kaplan-Meier plots.
RESULTS: A total of 537 adrenalectomized PA patients and 2148 matched controls were analyzed. Compared with controls, the adrenalectomy group exhibited a significantly increased risk of CKD/renal impairment (aHR 2.07; 95% CI, 1.58-2.72; p < 0.0001) and gout (aHR 1.54; 95% CI, 1.02-2.32; p = 0.048), while the elevated risk of hyperuricemia did not reach statistical significance (aHR 1.92; 95% CI, 0.82-4.52; p = 0.424). Kaplan-Meier curves demonstrated a higher cumulative incidence of CKD and gout over a 20-year period in the adrenalectomy group, whereas the divergence in hyperuricemia incidence was less pronounced. Stratified analyses revealed age- and sex-specific risk variations, and antihypertensive medication adjustment post-adrenalectomy was associated with differential risk. Among adrenalectomized patients, metabolic comorbidities and aging were key predictors of adverse outcomes.
CONCLUSION: Patients with PA who undergo unilateral adrenalectomy are at increased long-term risk of CKD and gout. These findings underscore the need for vigilant renal and metabolic monitoring postoperatively, particularly in older patients and those with predisposing comorbidities.
METHODS: We used the Longitudinal Generation Tracking Database (LGTD) from the Health and Welfare Data Science Center, Taiwan, which includes data from 2 million individuals insured since 2000. We identified 1,110 primary aldosteronism (PA) patients diagnosed between 2000 and 2019, excluding those with adrenal insufficiency or pre-existing hyperuricemia, gout, CKD, or plasma cell dyscrasia. The final cohort included 537 PA patients who underwent unilateral adrenalectomy, with a control group matched 4:1 using propensity scores based on age, gender, and comorbidities. Outcomes included new-onset CKD/renal impairment, hyperuricemia, and gout. Adjusted hazard ratios (aHRs) were estimated using Cox proportional hazards models, and cumulative incidence was visualized via Kaplan-Meier plots.
RESULTS: A total of 537 adrenalectomized PA patients and 2148 matched controls were analyzed. Compared with controls, the adrenalectomy group exhibited a significantly increased risk of CKD/renal impairment (aHR 2.07; 95% CI, 1.58-2.72; p < 0.0001) and gout (aHR 1.54; 95% CI, 1.02-2.32; p = 0.048), while the elevated risk of hyperuricemia did not reach statistical significance (aHR 1.92; 95% CI, 0.82-4.52; p = 0.424). Kaplan-Meier curves demonstrated a higher cumulative incidence of CKD and gout over a 20-year period in the adrenalectomy group, whereas the divergence in hyperuricemia incidence was less pronounced. Stratified analyses revealed age- and sex-specific risk variations, and antihypertensive medication adjustment post-adrenalectomy was associated with differential risk. Among adrenalectomized patients, metabolic comorbidities and aging were key predictors of adverse outcomes.
CONCLUSION: Patients with PA who undergo unilateral adrenalectomy are at increased long-term risk of CKD and gout. These findings underscore the need for vigilant renal and metabolic monitoring postoperatively, particularly in older patients and those with predisposing comorbidities.