Key result
High plasma aldosterone levels in patients with heart failure with preserved ejection fraction were independently associated with an increased risk of reduced glomerular filtration rate (OR 2.23) and severe albuminuria.
Why the study?
The study was conducted to assess the relationship between plasma aldosterone levels and renal function in patients with heart failure with preserved ejection fraction.
Is high plasma aldosterone associated with impaired renal function in patients with HFpEF?
Cross-Sectional (n=158)
Is high plasma aldosterone associated with impaired renal function in patients with HFpEF?
Effect estimate: OR 2.23 (95% CI 1.24-9.63)
Absolute Event Rate: 72.9% vs 41.4%
p-value: p=0.003
In patients with HFpEF, secondary hyperaldosteronism is independently associated with an increased risk of impaired renal filtration and severe albuminuria.
High aldosterone may mark renal risk in HFpEF; hypothesis-generating for targeted interventions pending prospective trials.
Objective: To assess the relationship between plasma aldosterone levels and renal function in patients with heart failure with preserved ejection fraction (HFpEF). Materials and methods: A cross-sectional study included 158 patients with confirmed HFpEF. Patients with primary hyperaldosteronism, edema syndrome, end stage renal disease and taking mineralocorticoid receptor antagonists were excluded. Renal function was assessed by determining daily urinary albumin excretion (UAE) and calculating the glomerular filtration rate (GFR). Plasma aldosterone was measured by enzyme immunoassay. Results: The patients were divided into two groups: 99 patients had normal (40-160 pg/ml) aldosterone plasma level (nAld) and 59 patients had high (> 160 pg/ml) aldosterone level (hAld). hAld patients had significantly higher UAE (median 342 mg/day [interquartile value 253; 453] versus 116 mg/day [32; 255], p < 0.001), and lower GFR (52 ml/min/1.73 m 2 [46; 67.5] versus 66 ml/min/1.73 m 2 [53; 79]) compared to nAld. The prevalence of impaired renal filtration function and severe albuminuria was higher in hAld group then in nAld (p < 0.001). In binomial logistic regression models adjusted for age, severity of HFpEF and comorbidities high aldosterone plasma level were independent risk factors of significant (< 60 ml/min/1.73 m2) decrease in GFR (odds ratio 4.25, 95% confidence interval 2.01-16.6) and very high (> 300 mg/day) albuminuria (odds ratio 2.23, 95% confidence interval 1.24-9.63). Conclusion: In HFpEF plasma aldosterone levels are closely related to renal function. Secondary hyperaldosteronism is associated with an increased risk of impaired renal filtration and severe albuminuria.
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A. N. Shevelok (2020) conducted a cross-sectional in Heart failure with preserved ejection fraction (HFpEF) (n=158). High aldosterone level (> 160 pg/ml) vs. Normal aldosterone level (40-160 pg/ml) was evaluated on Decreased glomerular filtration rate (< 60 ml/min/1.73 m2) (OR 2.23, 95% CI 1.24-9.63, p=0.003). High plasma aldosterone levels in patients with heart failure with preserved ejection fraction were independently associated with an increased risk of reduced glomerular filtration rate (OR 2.23) and severe albuminuria.
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