No “U-shaped” Associations of Estimated Glomerular Filtration Rate With Adverse Cardiovascular Outcomes in Patients With Primary Aldosteronism

A decreased glomerular filtration rate (GFR) is a predictor of cardiovascular disease and mortality in healthy people. The relationship between GFR and the incidence of cardiovascular events in patients with PA is unknown, although there have been reports of altered cardiovascular event incidence and renal prognosis depending on the choice of treatment and the post-treatment renin concentration. Because no studies have shown associations of baseline kidney function with long-term cardiovascular outcomes, Lai et al. recently investigated whether the calculated baseline 2021 race-free eGFR could predict new-onset composite cardiovascular events among patients with PA (total death, non-fatal myocardial infarction, and coronary revascularization events) in the Taiwan PA Investigation registry. Lai et al. showed no “U-shaped” associations between baseline eGFR and predicted cardiovascular outcomes in patients with PA. Instead, they found that among patients with PA, a higher eGFR was associated with a lower predicted cardiovascular risk; the greatest risk was associated with an eGFR of <85 mL/min/1.73 m². Based on these results, we suspect that most patients with PA initially exhibited a hyperfiltration state. The better prognosis for cardiovascular events in patients with a baseline 2021 race-free eGFR of ≥100 mL/min/1.73 m² suggests that patients with a baseline 2021 race-free eGFR of 90–100 mL/min/1.73 m² already had a reduced GFR secondary to progressive renal impairment. Based on this assumption, the management of patients with PA should include the expectation that renal or vascular damage has substantially progressed at the time of PA diagnosis.