Primary hyperaldosteronism in a patient with end-stage renal disease

The prevalence of hypertension in patients on chronic haemodialysis has been reported to be as high as 90% [1]. Several aetiological factors may contribute to hypertension in this population including sodium and water retention, increased activity of vasoconstrictive systems and increased arterial stiffness [2]. Recent studies show that primary aldosteronism is common in patients with hypertension, being present in up to 10% of all hypertensive individuals [3]. Our understanding of the physiological and pathophysiological actions of aldosterone has changed in recent years, and increasing evidence identifies that its role in the pathogenesis of hypertension is beyond its effects on renal tubular cell-mediated ion transport and NaCl retention. Here, we present a case of hypertension secondary to primary aldosteronism in an anuric patient on chronic haemodialysis who showed a dramatic response to aldosterone receptor blockade.