Sodium Restriction Concomitant With Sufficient Aldosterone Suppression May Be Associated With Renoprotective Effects in the Patients With Primary Aldosteronism

Objective: Primary aldosteronism (PA) is an independent risk factor for various cardiovascular diseases and chronic kidney disease, which makes it important to treat this condition at an early phase. Currently, the use of mineralocorticoid receptor antagonists (MRAs) is recommended for the treatment of bilateral type, mainly idiopathic hyperaldosteronism. However, recent reports suggest that the benefit of the treatment with MRAs is only obtained in the patients with enough aldosterone suppression, which is indicated as post-treatment plasma renin activity (PRA) >=1.0 ng/mL/h. Since PRA is affected by the amount of sodium intake, PRA elevation after MRAs treatment might partially reflect an adherence to strict sodium restriction, thereby leads to organ protective effects in PA patients. Design and method: A total of 91 patients who received eplerenone or esaxerenone for PA treatment were included. The patients with PRA>=1.0 ng/mL/h at one year after the initiation of MRAs were determined as responders, and others were determined as non-responders. The differences between responders and non-responders were analyzed. In addition, these patients were followed for another two years (total three years), and the transitions of estimated glomerular filtration (eGFR) among responders and non-responders were also compared. Results: The doses of MRAs were equivalent between responders and non-responders. Estimated sodium intake was significantly lower in responders (responders: non-responders; 156.2±42.3 mmol/day: 124.7±41.8 mmol/day P<0.05). Multivariate logistic regression analysis has shown that estimated sodium intake was an independent predictor for responders. During three years’ period, eGFR was significantly decreased in non-responders (pre-treatment: post-treatment; 73.0±14.7 ml/min: 69.5±14.1 ml/min P<0.05), whereas it was comparatively preserved in responders (pre-treatment: post-treatment; 68.3±17.9 ml/min: 68.0±19.0 ml/min P=0.84). Conclusions: The present study have shown that responders in PA patients may partially benefit from an adherence to sodium restriction. Sodium restriction concomitant with sufficient suppression of aldosterone effect may exert renoprotective effects for PA patients.