Analysis of the influencing factors for postoperative chronic kidney insufficiency in patients with primary aldosteronism / 中华泌尿外科杂志

ABSTRACT

Objective:To explore the influencing factors of postoperative chronic kidney disease (CKI) in patients with primary aldosteronism (PA).Methods:The clinical data of 103 patients who underwent adrenalectomy for PA in our center from August 2018 to August 2019 were analyzed retrospectively. There were 53 males and 50 females, aged (47.02±10.06) years old, including 27 diabetes patients (26.2%). The body mass index (BMI) were (24.47±3.24) kg/m 2, tumor maximum diameter were (15.61±5.66) mm, preoperative systolic blood pressure were (166.93±12.22) mmHg(1 mmHg=0.133 kPa), preoperative blood potassium were (3.35 ± 0.48) mmol/L, plasma aldosterone concentration (PAC) were (55.75±8.56)ng/dl, aldosterone-renin ratio(ARR) were (165.13±38.21) and preoperative glomerular filtration rate (GFR) were (77.96±14.77) ml/(min·1.73m 2). All patients underwent laparoscopic adrenalectomy. The operation time and bleeding volume were recorded. The GFR, blood potassium, PAC and ARR were recorded at the third month after surgery. The paired sample t test was used to compare GFR before and after surgery. Pearson correlation analysis was used to evaluate the correlation between the parameters and GFR after surgery. The independent predictors of GFR≤60ml/(min·1.73 m 2) were analyzed by univariate and multivariate logistic regression. Results:The surgery time were (85.37±21.66) min, and the bleeding volume were (10.54±4.84) ml. GFR (62.66±8.53) ml/(min·1.73 m 2) at 3 months after surgery was significantly different from that before surgery ( P<0.01). Univariate analysis showed that age ( OR=1.36, P<0.01), preoperative GFR ( OR=0.81, P<0.01), preoperative blood potassium ( OR=2.95, P=0.02), preoperative PAC ( OR=1.28, P<0.01) and preoperative ARR ( OR=1.08, P<0.01) were significantly correlated with postoperative CKI. In Pearson analysis, older age ( r=-0.51, P<0.01), lower preoperative GFR ( r=0.62, P<0.01), lower preoperative blood potassium( r=0.41, P=0.02), higher preoperative PAC ( r=-0.49, P<0.01) and higher preoperative ARR ( r=-0.56, P<0.01) increased the risk of CKI. Multivariate logistic regression analysis showed that age ( OR=1.26, P=0.05), preoperative GFR ( OR=0.79, P=0.02) and preoperative PAC( OR=1.29, P=0.01) were independent risk factors for postoperative CKI. Conclusions:CKI may occur in PA patients after adrenalectomy. PA patients with older age, higher preoperative PAC, higher preoperative ARR, lower preoperative blood potassium and lower preoperative GFR are more likely to have CKI. Age, preoperative GFR and preoperative PAC were independent predictors of CKI.