Comparison Of Renal Function Changes After Unilateral Adrenalectomy In Patients With Primary Aldosteronism And Non-primary Aldosteronism

ObjectiveCompare the changes of glomerular filtration rate and the incidence of acute kidney injury rate between Primary Aldosteronism(PA)and non-Primary Aldosteronism(non PA)patients who have undergone Unilateral adrenalectomy.Identify the potential independent risk factors which lead to acute kidney injury in these PA patients undergoing unilateral adrenalectomy.MethodsBetween January 2013,and June 2020,272 patients with unilateral adrenalectomy in the first affiliated hospital of Zhengzhou University were enrolled in this retrospective study,223 patients were finally included after the exclusion,According to the classification criteria of our study,86 patients were included in PA group,81 patients were included in non-PA functional group,and the remaining 56 patients were included in non-PA nonfunctional group.In terms of preoperative clinical data,changes in glomerular filtration rate and incidence of acute kidney injury after unilateral adrenalectomy,the differences between 3 groups were evaluated.Analyze the risk factors of acute kidney injury developing in PA group with Logistic regression analysis and estimate predictive ability of the risk factors with ROC curve analysis.ResultsA dramatic improvement of blood pressure,serum potassium level could be observed in PA group after adrenalectomy(P<0.01).PA group eGFR decreased from preoperative 1 01.57±16.98mL/min/1.73m2 to postoperative 92.08±25.47mL/min/1.73m2.Meanwhile,there was no significant difference between pre-and postoperative eGFR in non-PA functional and non-functional groups.The incidence of acute kidney injury after unilateral adrenalectomy in PA group was 16.3%(14/86),which was higher than 4.9%(4/81)in non-PA functional group and 5.4%(3/56)in non-PA nonfunctional group.Univariate and multivariate Logistic regression analysis showed that duration of hypertension[OR=1.358(1.115-1.654),P=0.002]and preoperative serum potassium[OR=0.050(0.007-0.361),P=0.003]were independent risk factors for acute kidney injury developing after surgery in PA group.ROC analysis showed that the area under curve(AUC)values of preoperative serum potassium and hypertension duration were 0.757 and 0.796 in predicting the postoperative acute renal injury,respectively.Conclusion1.The eGFR decline and the incidence of renal impairment after unilateral adrenalectomy in PA group were higher than that in non-PA group.2.Duration of hypertension and preoperative serum potassium were independent risk factors,they had certain predictive value for the development of acute kidney injury after surgery in PA group.