Urinary sodium potassium ratio is associated with clinical success after adrenalectomy in patients with unilateral primary aldosteronism

Abstract

Background: The urinary sodium potassium (NaK) ratio is associated with dietary sodium and potassium intake and blood pressure, and it also reflects the activity of aldosterone. Herein we evaluated the value of the urinary NaK ratio in predicting the surgical outcomes of patients with unilateral primary aldosteronism (uPA). Methods: This non-concurrent prospective cohort study was conducted from 2011 to 2017 and included 241 uPA patients who had undergone adrenalectomy. Predictors of successful clinical outcomes were analyzed using logistic regression. Results: Among the 241 uPA patients, 197 (81.7%) achieved clinical complete or partial success. A urinary sodium potassium ratio <3 (odds ratio (OR): 2.5; 95% confidence interval (CI): 1.2–5.4; p = 0.015), body mass index <25 kg/m2 (OR: 2.82; 95% CI: 1.31–6.06; p = 0.008), renin <1 ng/mL/h (OR: 2.51; 95% CI: 1.01–6.21; p = 0.047) and mean preoperative blood pressure >115 mmHg (OR: 5.02; 95% CI: 2.10–11.97; p < 0.001) could predict clinical success after adrenalectomy. Furthermore, higher pre-treatment plasma aldosterone (OR: 1.014; 95% CI 1.005–1.024; p = 0.002) or lower serum potassium (OR: 0.523; 95% CI: 0.328–0.836; p = 0.007) were correlated with lower urinary NaK ratio (<3), and log urinary NaK ratio was positively correlated with serum C-reactive protein ( β value 2.326; 95% CI 0.029–4.623; p = 0.047). Conclusions: uPA patients with a lower urinary NaK ratio, due to high plasma aldosterone and low serum potassium concentrations, were more likely to have clinical success after adrenalectomy. uPA patients with a higher urinary NaK ratio were associated with more severe inflammatory status, and possibly more resistant hypertension post-operatively.

Characteristics and Outcomes in Primary Aldosteronism Patients Harboring Glucocorticoid-Remediable Aldosteronism

“…The dietary habit might contribute to PA patients with different surgical outcomes. uPA patients with a lower urinary sodium-potassium (NaK) ratio were more likely to have clinical success after an adrenalectomy [ 27 ]. While urinary NaK ratio is associated with dietary sodium and potassium intake and blood pressure, it also reflects the aldosterone activity.…”

Authors’ response to a letter to the Editor from Zhu et al. re: Urinary sodium potassium ratio is associated with clinical success after adrenalectomy in patients with unilateral primary aldosteronism

“…We would like to thank Zhu et al . for their interest in our paper 1 and for taking time to express their concerns.…”

Urinary sodium potassium ratio is associated with clinical success after adrenalectomy in patients with unilateral primary aldosteronism

“…To the Editor, Lee et al should be commended for investigating whether urinary sodium potassium (uNaK) ratio could predict the clinical outcome of patients with unilateral primary aldosteronism (uPA) who have undergone adrenalectomy. 1 They concluded that uPA patients with a lower uNaK ratio would have better post-surgical clinical success. However, in our view, this conclusion should be made with caution for multiple reasons.…”

“…The study by Lee et al is meritorious in that it attempted to explore the usefulness of the uNaK ratio -a simple and inexpensive proxy of patient's adherence to lifestyle measures. 1 However, to determine whether the uNaK ratio does indeed provide an accurate prediction, known existing predictors of surgical outcome in uPA patients would, in our view, need to be considered and the diagnostic gain of adding the uNaK ratio over such already known predictors should more convincingly proven.…”