Abstract

Although adrenalectomy (ADX) is an established treatment for unilateral primary aldosteronism (uPA), the influence of age on the surgical outcomes is poorly understood. Therefore, we aimed to elucidate how age affects the clinical outcomes after treatments. We analyzed 153 older (≥ 65 years) and 702 younger patients (< 65 years) with uPA, treated either with ADX or mineralocorticoid receptor antagonist (MRA) in the Japan PA Study, and compared the estimated glomerular filtration rate (eGFR) or blood pressure over a 36-month period after treatments. ADX-treated patients showed severer biochemical indicators than MRA-treated patients. During 6 and 36 months, the eGFR decreased more prominently in older but not in younger patients with ADX than in those with MRA, which remained significant after adjustment with the inverse probability of treatment weighting (IPTW). There was a significant interaction between the age-groups and the treatment choices in the change of the eGFR with IPTW-adjusted analysis. The post-treatment dose of antihypertensive medication was lower in younger and higher in older patients with ADX than those with MRA. The clinical benefit of ADX differed between younger and older patients with uPA. These findings indicate the need for further validation on whether ADX can benefit older patients with uPA.

Details

Title
Age-stratified comparison of clinical outcomes between medical and surgical treatments in patients with unilateral primary aldosteronism
Author
Nakamaru Ryo 1 ; Yamamoto Koichi 1 ; Akasaka, Hiroshi 1 ; Rakugi Hiromi 1 ; Kurihara Isao 2 ; Yoneda Takashi 3 ; Ichijo Takamasa 4 ; Takuyuki, Katabami 5 ; Tsuiki Mika 6 ; Wada Norio 7 ; Yamada Tetsuya 8 ; Kobayashi Hiroki 9 ; Tamura Kouichi 10 ; Ogawa Yoshihiro 11 ; Kawashima Junji 12 ; Inagaki Nobuya 13 ; Fujita Megumi 14 ; Watanabe Minemori 15 ; Kamemura Kohei 16 ; Okamura Shintaro 17 ; Tanabe Akiyo 18 ; Naruse Mitsuhide 19 ; Itoh, Hiroshi 2 ; Fukuda Hisashi 5 ; Umakoshi Hironobu 6 ; Shibayama Yui 7 ; Murakami Masanori 8 ; Yoshimoto Takanobu 8 ; Haze Tatsuya 10 ; Sone Masakatsu 13 ; Takahashi, Katsutoshi 20 ; Matsuda Yuichi 21 ; Shibata Hirotaka 22 ; Otsuki Michio 23 ; Fujii Yuichi 24 ; Ogo Atsushi 25 ; Miyauchi Shozo 26 ; Yanase Toshihiko 27 ; Suzuki, Tomoko 28 ; Kawamura Takashi 29 ; Asano Mai 30 ; Fukuoka Tomikazu 31 ; Kai Tatsuya 32 ; Izawa Shoichiro 33 ; Yoshikawa Yuichiro 34 ; Hashimoto Shigeatsu 35 ; Yamada Masanobu 36 ; Sakamoto Ryuichi 37 ; Chiba Yoshiro 38 ; Okamoto Ryuji 39 ; Oki Kenji 40 ; Yabe Daisuke 41 

1  Osaka University Graduate School of Medicine, Department of Geriatric and General Medicine, Suita, Japan (GRID:grid.136593.b) (ISNI:0000 0004 0373 3971) 
2  Keio University, Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Tokyo, Japan (GRID:grid.26091.3c) (ISNI:0000 0004 1936 9959) 
3  Kanazawa University, Department of Health Promotion and Medicine of the Future, Graduate School of Medical Science, Kanazawa, Japan (GRID:grid.9707.9) (ISNI:0000 0001 2308 3329) 
4  Saiseikai Yokohamashi Tobu Hospital, Department of Diabetes and Endocrinology, Yokohama, Japan (GRID:grid.9707.9) 
5  St. Marianna University School of Medicine Yokohama City Seibu Hospital, Division of Metabolism and Endocrinology, Department of Internal Medicine, Yokohama, Japan (GRID:grid.412764.2) (ISNI:0000 0004 0372 3116) 
6  National Hospital Organization Kyoto Medical Center, Department of Endocrinology and Metabolism, Kyoto, Japan (GRID:grid.410835.b) 
7  Sapporo City General Hospital, Department of Diabetes and Endocrinology, Sapporo, Japan (GRID:grid.415261.5) (ISNI:0000 0004 0377 292X) 
8  Tokyo Medical and Dental University, Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo, Japan (GRID:grid.265073.5) (ISNI:0000 0001 1014 9130) 
9  Nihon University School of Medicine, Division of Nephrology, Hypertension and Endocrinology, Tokyo, Japan (GRID:grid.260969.2) (ISNI:0000 0001 2149 8846) 
10  Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan (GRID:grid.268441.d) (ISNI:0000 0001 1033 6139) 
11  Kyushu University, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Fukuoka, Japan (GRID:grid.177174.3) (ISNI:0000 0001 2242 4849) 
12  Kumamoto University, Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto, Japan (GRID:grid.274841.c) (ISNI:0000 0001 0660 6749) 
13  Kyoto University Graduate School of Medicine, Department of Diabetes, Endocrinology and Nutrition, Kyoto, Japan (GRID:grid.258799.8) (ISNI:0000 0004 0372 2033) 
14  University of Tokyo, Division of Nephrology and Endocrinology, Tokyo, Japan (GRID:grid.26999.3d) (ISNI:0000 0001 2151 536X) 
15  Okazaki City Hospital, Department of Endocrinology and Diabetes, Okazaki, Japan (GRID:grid.413724.7) 
16  Shinko Hospital, Department of Cardiology, Kobe, Japan (GRID:grid.415766.7) (ISNI:0000 0004 1771 8393) 
17  Tenri Hospital, Department of Endocrinology, Tenri, Japan (GRID:grid.416952.d) (ISNI:0000 0004 0378 4277) 
18  National Center for Global Health and Medicine, Department of Diabetes, Endocrinology and Metabolism, Tokyo, Japan (GRID:grid.45203.30) (ISNI:0000 0004 0489 0290) 
19  National Hospital Organization Kyoto Medical Center, Department of Endocrinology and Metabolism, Kyoto, Japan (GRID:grid.410835.b); Ijinkai Takeda General Hospital, Endocrine Center, Kyoto, Japan (GRID:grid.414554.5) (ISNI:0000 0004 0531 2361) 
20  Showa General Hospital, Division of Metabolism, Tokyo, Japan (GRID:grid.415825.f) (ISNI:0000 0004 1772 4742) 
21  Sanda City Hospital, Department of Cardiology, Sanda, Japan (GRID:grid.415825.f) 
22  Oita University, Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Yufu, Japan (GRID:grid.412334.3) (ISNI:0000 0001 0665 3553) 
23  Osaka University Graduate School of Medicine, Department of Metabolic Medicine, Suita, Japan (GRID:grid.136593.b) (ISNI:0000 0004 0373 3971) 
24  JR Hiroshima Hospital, Department of Cardiology, Hiroshima, Japan (GRID:grid.136593.b) 
25  National Hospital Organization Kyusyu Medical Center, Clinical Research Institute, Fukuoka, Japan (GRID:grid.470350.5) 
26  Uwajima City Hospital, Department of Internal Medicine, Uwajima, Japan (GRID:grid.417104.7) (ISNI:0000 0004 0640 6124) 
27  Fukuoka University, Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka, Japan (GRID:grid.411497.e) (ISNI:0000 0001 0672 2176) 
28  International University of Health and Welfare, Department of Public Health, School of Medicine, Narita, Japan (GRID:grid.411731.1) (ISNI:0000 0004 0531 3030) 
29  Kyoto University School of Public Health, Department of Preventive Services, Kyoto, Japan (GRID:grid.258799.8) (ISNI:0000 0004 0372 2033) 
30  Kyoto Prefectural University of Medicine, Department of Endocrinology and Metabolism, Kyoto, Japan (GRID:grid.272458.e) (ISNI:0000 0001 0667 4960) 
31  Matsuyama Red Cross Hospital, Department of Internal Medicine, Matsuyama, Japan (GRID:grid.416592.d) (ISNI:0000 0004 1772 6975) 
32  Saiseikai Tondabayashi Hospital, Department of Cardiology, Tondabayashi, Japan (GRID:grid.416592.d) 
33  Tottori University Hospital, Department of Endocrinology and Metabolism, Yonago, Japan (GRID:grid.412799.0) (ISNI:0000 0004 0619 0992) 
34  Misato Kenwa Hospital, Department of Endocrinology and Diabetes Mellitus, Misato, Japan (GRID:grid.412799.0) 
35  Fukushima Medical University Hospital, Department of Diabetes, Endocrinology and Metabolism, Fukushima, Japan (GRID:grid.471467.7) (ISNI:0000 0004 0449 2946) 
36  Gunma University Graduate School of Medicine, Department of Medicine and Molecular Science, Maebashi, Japan (GRID:grid.256642.1) (ISNI:0000 0000 9269 4097) 
37  Saiseikai Fukuoka General Hospital, Department of Diabetes and Endocrinology, Fukuoka, Japan (GRID:grid.416599.6) (ISNI:0000 0004 1774 2406) 
38  Mito Saiseikai General Hospital, Endovascular Treatment Group, Mito, Japan (GRID:grid.415975.b) (ISNI:0000 0004 0604 6886) 
39  Mie University Graduate School of Medicine, Department of Cardiology and Nephrology, Tsu, Japan (GRID:grid.260026.0) (ISNI:0000 0004 0372 555X) 
40  Hiroshima University, Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (GRID:grid.257022.0) (ISNI:0000 0000 8711 3200) 
41  Gifu University Graduate School of Medicine, Department of Diabetes and Endocrinology, Gifu, Japan (GRID:grid.256342.4) (ISNI:0000 0004 0370 4927) 
Publication year
2021
Publication date
2021
Publisher
Nature Publishing Group
e-ISSN
20452322
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1038/s41598-021-86290-3
ProQuest document ID
2615743335
Copyright
© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.