ArticleJournal of endocrinological investigation2026
Chronic kidney disease, hyperuricemia, and gout after adrenalectomy for primary aldosteronism: a 20-year population-based study.
Article in Journal of endocrinological investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionUnilateral adrenalectomy is a definitive treatment for patients with primary aldosteronism (PA), yet its long-term renal and metabolic consequences remain insufficiently characterized. This study aimed to evaluate the incidence, risk, and cumulative burden of chronic kidney disease (CKD)/renal impairment, hyperuricemia, and gout in patients undergoing adrenalectomy compared to matched controls.
methodsWe used the Longitudinal Generation Tracking Database (LGTD) from the Health and Welfare Data Science Center, Taiwan, which includes data from 2 million individuals insured since 2000. We identified 1,110 primary aldosteronism (PA) patients diagnosed between 2000 and 2019, excluding those with adrenal insufficiency or pre-existing hyperuricemia, gout, CKD, or plasma cell dyscrasia. The final cohort included 537 PA patients who underwent unilateral adrenalectomy, with a control group matched 4:1 using propensity scores based on age, gender, and comorbidities. Outcomes included new-onset CKD/renal impairment, hyperuricemia, and gout. Adjusted hazard ratios (aHRs) were estimated using Cox proportional hazards models, and cumulative incidence was visualized via Kaplan-Meier plots.
resultsA total of 537 adrenalectomized PA patients and 2148 matched controls were analyzed. Compared with controls, the adrenalectomy group exhibited a significantly increased risk of CKD/renal impairment (aHR 2.07; 95% CI, 1.58-2.72; p < 0.0001) and gout (aHR 1.54; 95% CI, 1.02-2.32; p = 0.048), while the elevated risk of hyperuricemia did not reach statistical significance (aHR 1.92; 95% CI, 0.82-4.52; p = 0.424). Kaplan-Meier curves demonstrated a higher cumulative incidence of CKD and gout over a 20-year period in the adrenalectomy group, whereas the divergence in hyperuricemia incidence was less pronounced. Stratified analyses revealed age- and sex-specific risk variations, and antihypertensive medication adjustment post-adrenalectomy was associated with differential risk. Among adrenalectomized patients, metabolic comorbidities and aging were key predictors of adverse outcomes.
conclusionPatients with PA who undergo unilateral adrenalectomy are at increased long-term risk of CKD and gout. These findings underscore the need for vigilant renal and metabolic monitoring postoperatively, particularly in older patients and those with predisposing comorbidities.
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