[Elevated serum aldosterone levels in dialysis patients: Are we underusing renin-angiotensin-aldosterone system blockers?]

Autor: Fernández-Reyes MJ; Servicio de Nefrología, Hospital General, Segovia, España. Electronic address: mfernandez@hgse.sacyl.es., Velasco S; Servicio de Nefrología, Hospital General, Segovia, España., Gutierrez C; Servicio de Nefrología, Hospital General, Segovia, España., Gonzalez Villalba MJ; Análisis Clínicos, Hospital Universitario La Paz, Madrid, España., Heras M; Servicio de Nefrología, Hospital General, Segovia, España., Molina A; Servicio de Nefrología, Hospital General, Segovia, España., Callejas R; Servicio de Nefrología, Hospital General, Segovia, España., Rodríguez A; Servicio de Nefrología, Hospital General, Segovia, España., Calle L; Servicio de Nefrología, Hospital General, Segovia, España., Lopes V; Centro de Diálisis Los Olmos, FRIAT, Segovia, España.
Jazyk: Spanish; Castilian
Zdroj: Hipertension y riesgo vascular [Hipertens Riesgo Vasc] 2017 Jul - Sep; Vol. 34 (3), pp. 108-114. Date of Electronic Publication: 2016 Dec 23.
DOI: 10.1016/j.hipert.2016.11.004
Abstrakt: Serum aldosteronelevels (SA) are a marker of cardiovascular (CV) risk in the general population.
Objective: To analyze SA levels in dialysis patients and its relationship with characteristics of dialysis; comorbidity; blood pressure and the use of blocking renin-angiotensin-aldosterone system agents (BSRAA).
Methods: We determined SA in 102 patients: 81 on hemodialysis (HD) and 21 on peritoneal dialysis. Mean age 71.4±12 years; 54.9% male; 29.4% diabetics. Mean time on dialysis 59.3±67 months. In 44 HD patients plasma renin activity (PRA) was measured.
Results: Mean SA was 72.6±114.9ng/dl (normal range 1.17-23.6ng/dl). A total of 57.8% of patients had above normal levels which were not related to dialysis characteristics or comorbidity. Only 21% of patients with heart failure and 19.2% with ischemic heart disease used BSRAA. A number of 25 patients treated with BSRAA had significantly lower levels of SA. There was an inverse correlation between AS and systolic blood pressure (SBP), and direct with PRA. The logistic regression analysis conducted to find SA levels above the median associated factors showed that SBP was the only independent risk variable in the overall population (OR 0.97; P=.022); in the 44 patients in whom PRA was determined this was the only independent risk factor (OR 2.24; P=.012).
Conclusions: A high percentage of dialysis patients have elevated levels of SA that are associated to diminished SBP and activated PRA and not to dialysis characteristics. In patients with a history of heart disease we underuse BSRAA.
(Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
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