SAT-541 Difference in Aldosterone Dependency Between Cardiovascular Diseases and Renal Impairments in Patients with Primary Aldosteronism

BACKGROUND: There have been several clinical studies examining the factors associated with cardiovascular disease (CVD) and renal impairment in patients with primary aldosteronism (PA); however, their results have left it unclear as to whether they are affected by the plasma aldosterone concentration (PAC) itself. Method: This is a retrospective cross-sectional study. We assessed the PA database established by the multicenter JPAS (Japan Primary Aldosteronism Study) and compared the prevalences of CVD (stroke, ischemic heart disease, and heart failure) and renal impairment (proteinuria and lowered eGFR) among patients with PA and those with essential hypertension (EHT). We also performed logistic regression analysis to determine which parameters significantly increased the odds ratio for these complications. Results: The prevalence of CVD was significantly higher among 2814 patients with PA than among matched patients with EHT. The prevalence of proteinuria was also significantly higher among PA than EHT patients, whereas there was no significant difference in the prevalence of lowered eGFR. Multivariable logistic regression analysis showed that the PAC significantly increases the adjusted odds ratios for proteinuria and lowered eGFR independent of other known risk factors. By contrast, the PAC was not linearly related to the adjusted odds ratio for CVD. Conclusion: Plasma aldosterone levels are closely associated with renal impairment in patients with PA. This is contrast to our finding that the PAC was not, itself, linearly associated with CVDs, such as stroke or ischemic heart disease. The mechanism underlying the kidney damage in patients with PA may thus differ from that affecting the cardiovascular system.