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

Ming-Jse Lee; Chiao-Yin Sun; Ching-Chu Lu; Yuan-Shian Chang; Heng-Chih Pan; Yen-Hung Lin; Vin-Cent Wu; Jeff S Chueh

doi:10.1177/2040622321990274

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

Ther Adv Chronic Dis. 2021 Feb 12:12:2040622321990274. doi: 10.1177/2040622321990274. eCollection 2021.

Authors

Ming-Jse Lee¹, Chiao-Yin Sun², Ching-Chu Lu³, Yuan-Shian Chang⁴, Heng-Chih Pan², Yen-Hung Lin⁵, Vin-Cent Wu⁵, Jeff S Chueh⁶

Affiliations

¹ Division of Nephrology, Ten Chen General Hospital, Taoyuan, Taiwan.
² Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.
³ Division of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Internal Medicine, Postal Hospital, Taipei, Taiwan.
⁵ Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group, Internal Medicine, National Taiwan University Hospital, Taipei TAIPAI Taiwan.
⁶ Glickman Urological and Kidney Institute, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA Department of Urology, National Taiwan University, Taipei, Taiwan.

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.

Keywords: C-reactive protein; adrenalectomy; aldosterone; plasma renin activity; primary aldosteronism; urinary sodium potassium ratio.