Subclinical Primary Aldosteronism: A Novel Target to Improve Outcomes in Chronic Kidney Disease
Co-Applicant(s): Alexander Leung, Arya Rahgozar, David Colantonio, François Madore, Gregory Kline, Manish Sood, Mohsen Agharazii, Remi Goupil, Tim Ramsay
Lay Abstract
Background: Chronic kidney disease (CKD) affects 1 in 10 Canadians and leads to future heart and kidney damage. However, we do not know why some people with CKD develop these problems faster than others. Understanding the reasons for these differences may help doctors to personalize care for patients. One possibility is aldosterone, a hormone that causes salt retention. At very high levels, aldosterone raises blood pressure leading to damage of the heart and blood vessels, a condition called “Primary Aldosteronism” (or PA). Importantly, this damage is preventable when PA is treated early. Recent scientific studies show that a milder form of PA with moderately elevated aldosterone levels (called “Subclinical PA”) exists and is far more common than generally appreciated. However, it is unknown if Subclinical PA also causes heart and kidney damage.
Purpose: To study whether people with CKD and Subclinical PA are at higher risk of developing heart and kidney disease.
Method: We plan to study 3,000 patients with CKD from a large multi-center study (named CRIC) where we expect to find many patients with Subclinical PA. Participants of CRIC had blood collected and stored years ago. Standardized follow-up was carefully performed afterwards, such that all patients had their medical data recorded at regular intervals. We will be checking each patient’s aldosterone level to see if patients with Subclinical PA experience a higher risk of heart and kidney damage.
Anticipated Outcomes: We anticipate that CKD patients with Subclinical PA have a higher risk of heart disease and faster progression to kidney failure.
Patient Engagement: Our research team includes patient-partners who have lived experience with both PA and CKD. These individuals provided valuable input from the patient perspective to help design the study in such a way that we will capture the results most important to patients. These patient-partners will also assist with developing patient-friendly updates to inform the general public of the findings from our study.
Relevance to Patients/Community: If we find that Subclinical PA is common and increases the risk of heart and kidney disease, this will help us understand that even moderately high levels of aldosterone are dangerous. If doctors then learn to diagnose this in other patients, it may identify people who will greatly benefit from underused and inexpensive aldosterone-blocking medications.
Conclusion: Subclinical PA provides a new, unexplored target to improve the health of patients living with CKD. Studying the impact of Subclinical PA on heart and kidney disease may provide the opportunity for new treatments to help people with CKD live longer and healthier lives.
