Kidney function predicts new-onset cardiorenal events and mortality in primary aldosteronism: approach of the 2021 race-free eGFR equation

Exploring the high prevalence, comorbidities, and indicators of mild autonomous cortisol secretion in primary aldosteronism: a cohort study and systematic review

Emerging evidence has suggested a significant prevalence of mild autonomous cortisol secretion (MACS) among patients diagnosed with primary aldosteronism (PA). However, MACS's clinical characteristics and implications in PA patients remain largely unexplored. To investigate the prevalence, comorbidities, and indicators of MACS in PA patients, we conducted a retrospective cohort study including 874 PA patients with dexamethasone suppression test results in the Taiwan Primary Aldosteronism Investigators (TAIPAI) cohort between February 2011 and February 2024. Additionally, we performed a systematic review and meta-analysis of 11 studies, encompassing a total of 2882 PA patients (CRD42023486755). After including the TAIPAI cohort data in the meta-analysis, the prevalence of MACS among PA patients was 21.9% (95% confidence interval [C.I.]: 18.1, 26.2), with a negative correlation with estimated glomerular filtration rate (eGFR) (r = -0.028, P < 0.01). The characteristics associated with MACS in PA patients included older age (mean difference [MD] = 5.51 year, P < 0.01), higher plasma aldosterone concentration (MD = 5.36 ng/dL, P < 0.01), lower plasma renin activity (MD = -0.15 ng/mL/h, P < 0.01), lower eGFR (MD = -4.91 mL/min/1.73 m2, P = 0.01), and larger adrenal tumor size (MD = 0.41 cm, P < 0.01). MACS was significantly associated with chronic kidney disease (odds ratio [OR] = 1.96, P < 0.01), diabetes mellitus (OR = 1.60, P = 0.04), and cardiovascular diseases (OR = 1.37, P = 0.02) among PA patients. The high prevalence and strong association of MACS with comorbidities underscore the importance of identifying it in PA patients. Clinical features such as advanced age, significant aldosterone-renin dysregulation, impaired kidney function, diabetes, cardiovascular disease, and large adrenal tumors are indicators for MACS screening in PA patients.

The Prevalence of Obstructive Sleep Apnea in Patients With Primary Aldosteronism

CONTEXT

Investigating the co-occurrence of obstructive sleep apnea (OSA) and primary aldosteronism (PA) is crucial for understanding their interrelation.

OBJECTIVE

This work aimed to evaluate the prevalence of OSA in individuals diagnosed with PA and to assess the prevalence of PA within the OSA population, with a specific focus on hypertensive individuals.

METHODS

An exhaustive search was performed across PubMed, Embase, CINAHL, Scopus, and Web of Science up to September 2023, without restrictions on language or publication date. Studies were selected based on their focus on the prevalence of OSA in PA patients and vice versa, specifically in hypertensive individuals. Data were extracted using standard guidelines, focusing on patient characteristics, prevalence rates, and other relevant clinical parameters.

RESULTS

Proportional meta-analysis using a random-effects model revealed a 59.8% prevalence of OSA in hypertensive PA patients, with 45.4% exhibiting moderate-to-severe OSA. Meta-regression showed no significant effect of age, sex, body mass index, antihypertensive medication, systolic blood pressure, diastolic blood pressure, or serum potassium on OSA prevalence. However, a significant positive association was found with the glomerular filtration rate (GFR) (P < .001). Subgroup analysis also revealed that a hyperfiltration rate (GFR ≥ 100 mL/min per 1.73 m2) may be associated with a higher prevalence of OSA (71%, P value for interaction < .01). Among hypertensive OSA patients, 11.2% had PA.

CONCLUSION

A substantial prevalence of OSA in individuals with PA was identified, demonstrating a complex interplay between these conditions in hypertensive patients. Notably, the prevalence of OSA was significantly associated with kidney hyperfiltration.