Extracellular Volume and Aldosterone Interaction in Chronic Kidney Disease

Klemmer, Philip J.; Bomback, Andrew S.

doi:10.1159/000167016

Cited by 9 publications

(6 citation statements)

References 96 publications

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“…We hypothesised that patients with chronic and ESKD similarly manifest relative hyperaldosteronaemic and hypervolaemic states, which become more pronounced as renal function deteriorates 9. The volume-aldosterone curves constructed in this study support this hypothesis.…”

Section: Discussionsupporting

confidence: 68%

“…In other words, we hypothesised that the volume-aldosterone curve would ‘shift to the right’ as renal function declined (figure 1B). 9…”

Section: Introductionmentioning

confidence: 99%

“…In other words, we hypothesised that the volume-aldosterone curve would 'shift to the right' as renal function declined (figure 1B). 9 Disordered aldosterone-volume relationship in end-stage kidney disease Subjects Five clinically-stable, long-term (i.e. vintage ≥ one year) haemodialysis patients from the outpatient dialysis units of the University of North Carolina Kidney Center, believed to be at variable levels of hydration, were enrolled in this study.…”

Section: Introductionmentioning

confidence: 99%

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Disordered aldosterone-volume relationship in end-stage kidney disease

Bomback

Kshirsagar

Ferris

et al. 2009

J Renin Angiotensin Aldosterone Syst

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Introduction. Sodium loading, and subsequent volume expansion, suppresses aldosterone levels in individuals with normal renal function. We hypothesised that loss of renal function impairs this volume-aldosterone relationship. Materials and methods. With multifrequency bioimpedance spectroscopy, we measured total body water (TBW), extracellular volume (ECV), and intracellular volume in five haemodialysis patients at varied states of hydration and in five healthy volunteers during low-, normal-, and high-salt diets. Serum aldosterone, potassium, and C-reactive protein were measured simultaneously. Scatterplots and general estimating equations were used to examine the relationship among these variables.

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Section: Discussionsupporting

confidence: 68%

“…In other words, we hypothesised that the volume-aldosterone curve would ‘shift to the right’ as renal function declined (figure 1B). 9…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Disordered aldosterone-volume relationship in end-stage kidney disease

Bomback

Kshirsagar

Ferris

et al. 2009

J Renin Angiotensin Aldosterone Syst

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“…This factor may explain the inverse association between aldosterone level and mortality because volume overload is strongly associated with lower aldosterone levels and higher mortality [13]. In view of the particularly high incidence of CVD in dialysis patients, a better understanding of the diagnostic implications of aldosterone levels in these patients is needed.…”

Section: Introductionmentioning

confidence: 99%

Aldosterone and Mortality in Hemodialysis Patients: Role of Volume Overload

Hung

Lin

Huang³

et al. 2013

PLoS ONE

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BackgroundElevated aldosterone is associated with increased mortality in the general population. In patients on dialysis, however, the association is reversed. This paradox may be explained by volume overload, which is associated with lower aldosterone and higher mortality.MethodsWe evaluated the relationship between aldosterone and outcomes in a prospective cohort of 328 hemodialysis patients stratified by the presence or absence of volume overload (defined as extracellular water/total body water >48%, as measured with bioimpedance). Baseline plasma aldosterone was measured before dialysis and categorized as low (<140 pg/mL), middle (140 to 280 pg/mL) and high (>280 pg/mL).ResultsOverall, 36% (n = 119) of the hemodialysis patients had evidence of volume overload. Baseline aldosterone was significantly lower in the presence of volume overload than in its absence. During a median follow-up of 54 months, 83 deaths and 70 cardiovascular events occurred. Cox multivariate analysis showed that by using the low aldosterone as the reference, high aldosterone was inversely associated with decreased hazard ratios for mortality (0.49; 95% confidence interval, 0.25–0.76) and first cardiovascular event (0.70; 95% confidence interval, 0.33−0.78) in the presence of volume overload. In contrast, high aldosterone was associated with an increased risk for mortality (1.97; 95% confidence interval, 1.69–3.75) and first cardiovascular event (2.01; 95% confidence interval, 1.28−4.15) in the absence of volume overload.ConclusionsThe inverse association of aldosterone with adverse outcomes in hemodialysis patients is due to the confounding effect of volume overload. These findings support treatment of hyperaldosteronemia in hemodialysis patients who have achieved strict volume control.

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“…In other studies among resistant hypertensive subjects, higher aldosterone levels were correlated with higher degrees of proteinuria; moreover, among the high aldosterone subjects, the elevations in proteinuria were linearly related to 24-hour urinary sodium levels (a surrogate for extracellular volume) [31, 32]. Thus, while hyperaldosteronism and expanded extracellular volume can, individually, be risk factors for kidney injury, their combined presence likely exhibits a multiplicative effect [33]. This pathological milieu likely exists in obesity.…”

Section: Non-epithelial Effects Of Aldosteronementioning

confidence: 98%

Interaction of Aldosterone and Extracellular Volume in the Pathogenesis of Obesity-Associated Kidney Disease: A Narrative Review

Bomback

Klemmer

2009

Am J Nephrol

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Obesity and obesity-associated kidney injuries have played an important role in the rising prevalence of chronic kidney disease (CKD). The link between obesity and kidney disease begins with obesity’s well-known associations with diabetes and hypertension, the two leading etiologies of CKD. However, a growing body of evidence suggests that elevated aldosterone levels and expanded extracellular volume are key components of obesity-induced renal disease via aldosterone’s non-epithelial effects on the kidney. Highlighting these blood pressure- and diabetes-independent mechanisms of kidney injury in obesity allows an exploration of whether mineralocorticoid receptor blockade, coupled with weight loss and salt restriction, is an optimal treatment for overweight CKD patients.

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Extracellular Volume and Aldosterone Interaction in Chronic Kidney Disease

Cited by 9 publications

References 96 publications

Disordered aldosterone-volume relationship in end-stage kidney disease

Disordered aldosterone-volume relationship in end-stage kidney disease

Aldosterone and Mortality in Hemodialysis Patients: Role of Volume Overload

Interaction of Aldosterone and Extracellular Volume in the Pathogenesis of Obesity-Associated Kidney Disease: A Narrative Review

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