Chronic kidney disease score for predicting postoperative masked renal insufficiency in patients with primary aldosteronism

<jats:title>Summary</jats:title><jats:sec><jats:title>Context</jats:title><jats:p>Chronic kidney disease (<jats:styled-content style="fixed-case">CKD</jats:styled-content>) is sometimes unmasked after unilateral adrenalectomy in patients with primary aldosteronism (<jats:styled-content style="fixed-case">PA</jats:styled-content>) without expectation.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>Our study aim was to elucidate factors responsible for developing postoperative <jats:styled-content style="fixed-case">CKD</jats:styled-content> and to provide a simple scoring system to predict postoperative <jats:styled-content style="fixed-case">CKD</jats:styled-content> in <jats:styled-content style="fixed-case">PA</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Design and Patients</jats:title><jats:p>Forty‐five patients with PA treated with unilateral adrenalectomy and followed for at least 1 month postsurgery were studied. Thirty‐one patients with non‐PA adrenal disease who underwent unilateral adrenalectomy were also studied as control. Patients with pre‐operative estimated glomerular filtration rate (e<jats:styled-content style="fixed-case">GFR</jats:styled-content>) < 60 ml/min/1·73 m<jats:sup>2</jats:sup> were excluded from both groups.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A statistically significant (<jats:italic>P </jats:italic><<jats:italic> </jats:italic>0·001) decrease in <jats:styled-content style="fixed-case">eGFR</jats:styled-content> was observed in PA group within 1 month of surgery, then stabilized. Of the 45 patients with PA, 17 (37·8%) developed CKD after surgery. None of the non‐PA group developed CKD after surgery. Of the pre‐operative variables, logistic regression analysis showed that lower <jats:styled-content style="fixed-case">eGFR</jats:styled-content> and higher aldosterone‐to‐renin ratios (ARR) were the independent predictors for postoperative CKD in PA. Optimal cut‐off values of the two variables analysed with ROC curves were as follows: e<jats:styled-content style="fixed-case">GFR</jats:styled-content> ≤ 76·9 ml/min/1·73 m<jats:sup>2</jats:sup> and ARR ≥ 305. Using these data, we created a CKD score as a tool for predicting postoperative CKD, with an AUC for the score of 0·8866.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The pre‐operative e<jats:styled-content style="fixed-case">GFR</jats:styled-content> and ARR were the significant contributing factors for postoperative CKD in PA. By combining these independent factors, we created a CKD score which provides useful information before surgery about the risk for development of postoperative CKD.</jats:p></jats:sec>