FRI155 Effect Of Reversal Of Renin Suppression On Renal Outcome In Medically Treated Primary Aldosteronism
Authors: Tsurutani Yuya , Katsuragawa Sho , Inoue Kosuke , Nakai Kazuki , Saito Jun , Nishikawa Tetsuo , Goto Atsushi 
Published: October 2023

Disclosure: Y. Tsurutani: None. S. Katsuragawa: None. K. Inoue: None. K. Nakai: None. J. Saito: None. T. Nishikawa: None. A. Goto: None.

Background and Objective: In the strategy of medical treatment with mineralocorticoid receptor antagonist (MRA) for primary aldosteronism (PA), achieving reversal of renin suppression, which reflects effective blockade of the mineralocorticoid receptor activation, is considered a reasonable approach. However, whether this approach mitigates long-term renal impairment is still unclear. We examined whether reversal of renin suppression after initiation of MRA affects the long-term renal outcome among patients with medically treated PA. Methods: This study included 318 adults with primary aldosteronism who started MRA between 2008 to 2020. The post-treatment renin status was defined as unsuppressed (i.e., reversal of renin suppression) when individual plasma renin activity at least 6 months after the initiation of MRA (post-PRA) was 1.0 ng/mL/h or more; otherwise the post-treatment renin status was defined as suppressed. We analyzed the association of the post-treatment renin status with the change in subsequent longitudinal estimated glomerular filtration rate (eGFR) using linear mixed-effects models for repeated measurements. Results: Among 318 patients analyzed, the post-treatment renin status of 119 patients was unsuppressed (median post-PRA [interquartile range] = 1.7 [1.3-2.5] ng/mL/h) and that of 199 patients was suppressed (median post-PRA [interquantile range] = 0.5 [0.3-0.7] ng/mL/h). Through the median follow-up period of 3.1 years, the decline in eGFR was less severe among patients with the unsuppressed post-treatment renin (−0.554 [95% CI, −0.73 to -0.36] ml/min/1.73m2/year) compared to those with suppressed renin (−1.42 [95% CI, −1.56 to −1.27] ml/min/1.73m2/year; deference, 0.87 [95% CI, 0.62 to 1.12] ml/min/1.73m2/year) after adjusting for potential confounders. In subgroup analyses, the difference in annual eGFR change by the post-treatment renin status was greater among female patients (1.17 [95% CI, 0.82 to 1.53] ml/min/1.73m2/year) than male patients (0.60 [95% CI, 0.27 to 0.94] ml/min/1.73m2/year; P-for-interaction = 0.02), among overweight patients (1.14 [95% CI, 1.04 to 1.78] ml/min/1.73m2/year) than non-overweight patients (0.46 [95% CI, 0.15 to 0.77] ml/min/1.73m2/year; P-for-interaction &lt; 0.01), and among patients with higher plasma renin activity at baseline (1.38 [95% CI, 0.90 to 1.86] ml/min/1.73m2/year) than those with lower plasma renin activity at baseline (0.69 [95% CI, 0.39 to 0.99] ml/min/1.73m2/year; P-for-interaction = 0.02). Conclusion: The post-treatment unsuppressed renin was associated with subsequent milder eGFR decline. Our findings indicate the importance of reversal of renin suppression with optimal MRA titration for medically treated primary aldosteronism that could mitigate the adverse renal outcome.

Presentation: Friday, June 16, 2023