E-Poster Presentation ESA-SRB-ANZBMS 2021

Screening for primary aldosteronism underutilised in a cohort of patients with chronic kidney disease (#317)

Karan Chauhan 1 , Eitan Schachna 2 , Renata Libianto 3 4 , Jessica Ryan 5 , Holly Hutton 6 , Peter J Fuller 3 4 , Peter G Kerr 5 , Scott Wilson 2 6 , Jun Yang 1 3 4
  1. Medicine, Monash University, School of Clinical Sciences, Clayton, Victoria, Australia
  2. Medicine, Monash University Central Clinical School, Melbourne, Victoria, Australia
  3. Endocrinology, Monash Health, Clayton, Victoria, Australia
  4. Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
  5. Nephrology, Monash Health, Clayton, Victoria, Australia
  6. Nephrology, Alfred Health, Melbourne, Victoria, Australia

Background

 

Primary aldosteronism (PA) is the most common and potentially curable endocrine cause of secondary hypertension, and carries a worse prognosis than essential hypertension. Despite the high prevalence of hypertension in patients with chronic kidney disease (CKD), the screening rates for PA in CKD are unknown.

Methods

 

In this study, we retrospectively reviewed medical records of 1627 adults with CKD who presented to the nephrology clinics of 2 tertiary hospitals in Melbourne, Australia, between January 2014 and April 2019.  In addition to assessing the pattern of screening, we also evaluated patient-specific factors associated with the decision to test for PA.

Results

 

Of the 600 patients included in the final analysis, 234 (39%) had an indication for PA screening based on recommendations made by the Endocrine Society.  However, only 33 (14%) were tested. They were younger (median age, 58 vs 72 years), had a higher mean systolic BP (153 vs 140 mmHg), better renal function (mean eGFR 51 vs 37 mL/min/1.73m2), and lower mean serum potassium (4.1 vs 4.5 mEq/L) than those who were indicated but not screened. Of the 33 screened patients, an elevated ARR was noted in 8 patients and a diagnosis of PA was made in 4 patients.

Conclusions

 

The screening rate for PA is low in a CKD population, especially in patients who are older, have a lower eGFR and normal serum potassium. The consequences of undiagnosed PA in this select population may be substantial due to the cardiovascular and renal sequelae associated with untreated disease.