Serum aldosterone and death, end-stage renal disease, and cardiovascular events in blacks and whites

Findings from the chronic renal insufficiency cohort (CRIC) study

Rajat Deo, Wei Yang, Abigail Khan, Nisha Bansal, Xiaoming Zhang, Mary B. Leonard, Martin G. Keane, Elsayed Z. Soliman, Susan Steigerwalt, Raymond R. Townsend, Michael G. Shlipak, Harold I. Feldman

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Prior studies have demonstrated that elevated aldosterone concentrations are an independent risk factor for death in patients with cardiovascular disease. Limited studies, however, have evaluated systematically the association between serum aldosterone and adverse events in the setting of chronic kidney disease. We investigated the association between serum aldosterone and death and end-stage renal disease in 3866 participants from the Chronic Renal Insufficiency Cohort. We also evaluated the association between aldosterone and incident congestive heart failure and atherosclerotic events in participants without baseline cardiovascular disease. Cox proportional hazards models were used to evaluate independent associations between elevated aldosterone concentrations and each outcome. Interactions were hypothesized and explored between aldosterone and sex, race, and the use of loop diuretics and renin-angiotensin-aldosterone system inhibitors. During a median follow-up period of 5.4 years, 587 participants died, 743 developed end-stage renal disease, 187 developed congestive heart failure, and 177 experienced an atherosclerotic event. Aldosterone concentrations (per SD of the log-transformed aldosterone) were not an independent risk factor for death (adjusted hazard ratio, 1.00; 95% confidence interval, 0.93-1.12), end-stage renal disease (adjusted hazard ratio, 1.07; 95% confidence interval, 0.99-1.17), or atherosclerotic events (adjusted hazard ratio, 1.04; 95% confidence interval, 0.85-1.18). Aldosterone was associated with congestive heart failure (adjusted hazard ratio, 1.21; 95% confidence interval, 1.02-1.35). Among participants with chronic kidney disease, higher aldosterone concentrations were independently associated with the development of congestive heart failure but not for death, end-stage renal disease, or atherosclerotic events. Further studies should evaluate whether mineralocorticoid receptor antagonists may reduce adverse events in individuals with chronic kidney disease because elevated cortisol levels may activate the mineralocorticoid receptor.

Original languageEnglish (US)
Pages (from-to)103-110
Number of pages8
JournalHypertension
Volume64
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Aldosterone
Chronic Renal Insufficiency
Chronic Kidney Failure
Cohort Studies
Serum
Heart Failure
Confidence Intervals
Cardiovascular Diseases
hydroquinone
Mineralocorticoid Receptor Antagonists
Sodium Potassium Chloride Symporter Inhibitors
Mineralocorticoid Receptors
Renin-Angiotensin System
Proportional Hazards Models
Hydrocortisone

Keywords

  • aldosterone
  • death
  • heart failure
  • renal insufficiency, chronic

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Serum aldosterone and death, end-stage renal disease, and cardiovascular events in blacks and whites : Findings from the chronic renal insufficiency cohort (CRIC) study. / Deo, Rajat; Yang, Wei; Khan, Abigail; Bansal, Nisha; Zhang, Xiaoming; Leonard, Mary B.; Keane, Martin G.; Soliman, Elsayed Z.; Steigerwalt, Susan; Townsend, Raymond R.; Shlipak, Michael G.; Feldman, Harold I.

In: Hypertension, Vol. 64, No. 1, 2014, p. 103-110.

Research output: Contribution to journalArticle

Deo, R, Yang, W, Khan, A, Bansal, N, Zhang, X, Leonard, MB, Keane, MG, Soliman, EZ, Steigerwalt, S, Townsend, RR, Shlipak, MG & Feldman, HI 2014, 'Serum aldosterone and death, end-stage renal disease, and cardiovascular events in blacks and whites: Findings from the chronic renal insufficiency cohort (CRIC) study', Hypertension, vol. 64, no. 1, pp. 103-110. https://doi.org/10.1161/HYPERTENSIONAHA.114.03311
Deo, Rajat ; Yang, Wei ; Khan, Abigail ; Bansal, Nisha ; Zhang, Xiaoming ; Leonard, Mary B. ; Keane, Martin G. ; Soliman, Elsayed Z. ; Steigerwalt, Susan ; Townsend, Raymond R. ; Shlipak, Michael G. ; Feldman, Harold I. / Serum aldosterone and death, end-stage renal disease, and cardiovascular events in blacks and whites : Findings from the chronic renal insufficiency cohort (CRIC) study. In: Hypertension. 2014 ; Vol. 64, No. 1. pp. 103-110.
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