Primary Aldosteronism in CKD
Bibliographic record
Abstract
Background: Primary aldosteronism (PA) is a common cause of secondary hypertension. Unilateral causes of PA are potentially cured with adrenalectomy. Treatment of PA in CKD is often avoided for concerns of safety and efficacy. Methods: We conducted a retrospective cohort study of patients with PA and CKD (eGFR <60 ml/min/1.73m2) at 3 institutions (2009-2019). eGFR was calculated using CKD-EPI. Statistical comparison utilized the student’s t-test, Chi-square test, and Wilcoxon rank-sum test. Results: Of 250 patients included, mean age was 56.6years (±10.5), and 64% were female. Median plasma aldosterone concentration was 29.0 ng/dl (IQR:20.3-47.4); median plasma renin activity was 0.2 ng/ml/hr (IQR:0.1-0.6) and aldosterone-renin ratio was 119 (ng/dl)/(ng/ml/hr) (IQR:63.5-240.0). Median eGFR on initial evaluation was 49.0 ml/min/1.73m2 (IQR:40.3-58.2). Adrenal vein sampling (AVS) was performed in all patients; unilateral PA was diagnosed in 67.6% (n=169). Adrenalectomy was performed in 163 subjects. Surgical pathology demonstrated adrenocortical adenomas in 66.9%, nodular hyperplasia in 4.9%, and nodular hyperplasia with a dominant nodule in 10.4%. The median tumor size was 1.2 cm (IQR:1.0-1.8). No differences were detected in baseline MAP, number of anti-hypertensive medications (AHM), serum creatinine, or potassium levels between adrenalectomy patients and those medically managed. Adrenalectomy patients had significantly lower AHM requirements at 1 month (2.0 vs. 4.5, p<0.001), 6 months (2.0 vs. 3.0, p=0.002) and 12 months after surgery (2.0 vs. 4.0, p<0.001) compared with medically managed patients. Adrenalectomy patients demonstrated stable eGFR from baseline to 12 months postoperatively, while medically managed patients had a statistically significant decrease in eGFR from baseline to 12 months (p=0.040). There was no difference between groups in cardiovascular outcomes. Conclusions: Patients with CKD and unilateral PA experience significant and durable decrease in AHM requirement and demonstrate stabilization of eGFR after adrenalectomy when compared to medically managed patients. AVS was successful despite reduced GFR. This study demonstrates that patients with CKD and suspected PA should undergo evaluation to determine whether they have surgically curable disease, as there is a clear benefit in medication reduction and stabilization of eGFR at 12 months.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".