Aldosterone, a hormone that prevents dehydration, is linked to worsening kidney disease, study suggests

“In the observational study [published in the European Heart Journal on 2022.8.7], researchers analyzed health data from 3,680 people with chronic kidney disease for nearly 10 years. Those with elevated levels of aldosterone, a crucial, salt-conserving hormone made by the adrenal glands, which sit atop the kidneys, had a higher risk of serious kidney disease progression during the study period: they are more likely to lose half their kidney function, start dialysis, or develop end-stage kidney disease.

[Excerpts of an interview with Ashish Verma, kidney specialist and assistant professor of medicine at Boston University School of Medicine:]

[Verma:] We found that higher aldosterone levels were associated with the progression of kidney disease, and even with going on dialysis (a sign of severe kidney disease). There was a risk for kidney disease progression with high aldosterone levels, irrespective of if you have diabetes or not.

[STAT:] What is known about how finerenone or similar drugs might work in people without diabetes who have chronic kidney disease?

[Verma:] Interestingly, there is a trial going on, the FIND-CKD trial, which is testing finerenone to halt kidney disease progression in people who do not have diabetes. So we’re going to know soon, maybe next year, if these drugs are associated with decreased kidney disease progression.

Older drugs, like spironolactone or eplerenone, can cause very high potassium levels in people with low kidney function (which can lead to life-threatening heart problems). So people feared always using it. And even in my clinic, if I use these drugs on patients, I test their potassium and make sure their potassium stays okay. That was one of the hindrances for using these drugs.

But now, with more evidence in front of us that high aldosterone concentration is bad, doctors should also be checking aldosterone levels in people with diabetes, people with resistant hypertension (high blood pressure that doesn’t respond to three or more antihypertensive drugs, including a diuretic) or people with central obesity. Dr. [Anand] Vaidya, co-author of this study, showed in his previous publication that excess aldosterone is very common in normal populations, but we don’t check for it, so it’s a very unrecognized disease in the general population. [..]

[STAT:] What surprised you throughout the research process?

[Verma:] What we found at baseline was that the lower a person’s kidney function, the higher their aldosterone is. We don’t know the mechanism of it. Maybe future studies will find out why that happens. Second, when somebody’s kidney function is low, they tend to excrete less potassium in the urine, so potassium in the blood gets high. But we found the opposite: people who had lower kidney function and high aldosterone actually have lower potassium [in the blood], which fits the mechanism because if you have higher aldosterone, you can excrete more potassium in the urine. So it fit the mechanism that, yes, this aldosterone was pathogenic in these patients; it was not doing the work it does in healthy people.”

Full article, I Cueto, STAT, 2022.8.8