Aldosterone and Mortality in Hemodialysis Patients: Role of Volume Overload

Hung, Szu-Chun; Lin, Yao-Ping; Huang, Hsin-Lei; Pu, Hsiao-Fung; Tarng, Der-Cherng
February 2013
PLoS ONE;Feb2013, Vol. 8 Issue 2, p1
Academic Journal
Background: Elevated 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. Methods: We 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). Results: Overall, 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. Conclusions: The 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.


Related Articles

  • Effect of hyperinsulinemia during hemodialysis on the insulin-like growth factor system and inflammatory biomarkers: a randomized open-label crossover study. Reinhard, Mark; Frystyk, Jan; Jespersen, Bente; Bjerre, Mette; Christiansen, Jens S.; Flyvbjerg, Allan; Ivarsen, Per // BMC Nephrology;2013, Vol. 14 Issue 1, p1 

    Background: A marked reduction in serum levels of bioactive insulin-like growth factor-I (IGF-I) has been observed in fasting hemodialysis (HD) patients during a 4-h HD session. The aim of the present study was to investigate the beneficial effect of hyperinsulinemia during HD on bioactive IGF-I...

  • Nephrologists' perspectives on dialysis treatment: results of an international survey. Fluck, Richard J.; Fouque, Denis; Lockridge Jr., Robert S. // BMC Nephrology; 

    Background In-centre haemodialysis (ICHD) is the most common dialysis method used by patients worldwide. However, quality of life and clinical outcomes in patients treated via ICHD have not improved for some time. 'High-dose' haemodialysis (HD) regimens - which are longer and/or more frequent...

  • MicroRNAs in Kidney Transplantation: Living up to Their Expectations? van den Akker, Eline K.; Dor, Frank J. M. F.; IJzermans, Jan N. M.; de Bruin, Ron W. F. // Journal of Transplantation;5/11/2015, Vol. 2015, p1 

    Since the discovery of microRNAs, ample research has been conducted to elucidate their involvement in an array of (patho)physiological conditions. Ischemia reperfusion injury is a major problem in kidney transplantation and its mechanism is still not fully known, nor is there an effective...

  • Acute kidney injury in critically ill newborns: What do we know? What do we need to learn? Askenazi, David; Ambalavanan, Namasivayam; Goldstein, Stuart // Pediatric Nephrology;Feb2009, Vol. 24 Issue 2, p265 

    Outcomes in critically ill neonates have improved over the past three decades, yet high residual mortality and morbidity rates exist. Acute kidney injury (AKI) is not just an innocent by-stander in the critically ill patient. Research on incidence and outcomes of AKI in the critically ill...

  • Linking Injury to Outcome in Acute Kidney Injury: A Matter of Sensitivity. Pickering, John W.; Endre, Zoltan H. // PLoS ONE;Apr2013, Vol. 8 Issue 4, p1 

    : Current consensus definitions of Acute Kidney Injury (AKI) utilise thresholds of change in serum or plasma creatinine and urine output. Biomarkers of renal injury have been validated against these definitions. These biomarkers have also been shown to be independently associated with mortality...

  • Epidemiology - CKD 5D II.  // Nephrology Dialysis Transplantation;May2013 Supplement, Vol. 28 Issue suppl_1, pi472 

    No abstract available.

  • Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study. Kruzan, Rachel M.; Herzog, Charles A.; Aozhou Wu; Yingying Sang; Parekh, Rulan S.; Matsushita, Kunihiro; Seungyoung Hwang; Cheng, Alan; Coresh, Josef; Powe, Neil R.; Shafi, Tariq; Wu, Aozhou; Sang, Yingying; Hwang, Seungyoung // BMC Nephrology;2/20/2016, Vol. 17, p1 

    Background: Sudden cardiac death (SCD) is the most common etiology of death in hemodialysis patients but not much is known about its risk factors. The goal of our study was to determine the association and risk prediction of SCD by serum N-terminal prohormone of brain natriuretic...

  • The Relation between Serum Phosphorus Levels and Clinical Outcomes after Acute Myocardial Infarction. Aronson, Doron; Kapeliovich, Michael; Hammerman, Haim; Dragu, Robert // PLoS ONE;Mar2013, Vol. 8 Issue 3, p1 

    Background: Elevated serum phosphorus levels have been linked with cardiovascular disease and mortality with conflicting results, especially in the presence of normal renal function. Methods: We studied the association between serum phosphorus levels and clinical outcomes in 1663 patients...

  • Evaluation of a Method for Fibroblast Growth Factor-23: A Novel Biomarker of Adverse Outcomes in Patients with Renal Disease. Sridevi Devaraj; Catherine Duncan-Staley; Ishwarlal Jialal // Metabolic Syndrome & Related Disorders;Dec2010, Vol. 8 Issue 6, p477 

    AbstractBackground:Fibroblast growth factor 23 (FGF-23), a phosphaturic peptide hormone secreted by the osteoblasts, is an important regulator of phosphorus and vitamin D metabolism. In chronic kidney disease, FGF-23 levels rise with declining kidney function. Increasing FGF-23 levels are...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics