Aldosterone and cortisol affect the risk of sudden cardiac death in haemodialysis patients.

Abstract

BACKGROUND:

Sudden cardiac death is common and accounts largely for the excess mortality of patients on maintenance dialysis. It is unknown whether aldosterone and cortisol increase the incidence of sudden cardiac death in dialysis patients.

METHODS AND RESULTS:

We analysed data from 1255 diabetic haemodialysis patients participating in the German Diabetes and Dialysis Study (4D Study). Categories of aldosterone and cortisol were determined at baseline and patients were followed for a median of 4 years. By Cox regression analyses, hazard ratios (HRs) were determined for the effect of aldosterone, cortisol, and their combination on sudden death and other adjudicated cardiovascular outcomes. The mean age of the patients was 66 ± 8 years (54% male). Median aldosterone was <15 pg/mL (detection limit) and cortisol 16.8 µg/dL. Patients with aldosterone levels >200 pg/mL had a significantly higher risk of sudden death (HR: 1.69; 95% CI: 1.06-2.69) compared with those with an aldosterone <15 pg/mL. The combined presence of high aldosterone (>200 pg/mL) and high cortisol (>21.1 µg/dL) levels increased the risk of sudden death in striking contrast to patients with low aldosterone (<15 pg/mL) and low cortisol (<13.2 µg/dL) levels (HR: 2.86, 95% CI: 1.32-6.21). Furthermore, all-cause mortality was significantly increased in the patients with high levels of both hormones (HR: 1.62, 95% CI: 1.01-2.62).

CONCLUSIONS:

The joint presence of high aldosterone and high cortisol levels is strongly associated with sudden cardiac death as well as all-cause mortality in haemodialysed type 2 diabetic patients. Whether a blockade of the mineralocorticoid receptor decreases the risk of sudden death in these patients must be examined in future trials.

• Authors: Christiane Drechsler, Eberhard Ritz, Andreas Tomaschitz, Stefan Pilz, Stephan Schönfeld, Katja Blouin, Martin Bidlingmaier, Fabian Hammer, Vera Krane, Winfried März, Bruno Allolio, Martin Fassnacht, Christoph Wanner
• Journal: European heart journal (Eur Heart J) Vol. 34 Issue 8 Pg. 578-87 (Feb 2013) ISSN: 1522-9645 [Electronic] England
• PMID: 23211232 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anticholesteremic Agents
• Heptanoic Acids
• Pyrroles
• Aldosterone
• Atorvastatin
• Hydrocortisone

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Aldosterone (metabolism)
• Anticholesteremic Agents (therapeutic use)
• Atorvastatin
• Death, Sudden, Cardiac (etiology)
• Drug Synergism
• Female
• Heptanoic Acids (therapeutic use)
• Humans
• Hydrocortisone (metabolism)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Pyrroles (therapeutic use)
• Randomized Controlled Trials as Topic
• Renal Dialysis (mortality)
• Renal Insufficiency, Chronic (mortality, therapy)
• Risk Factors
• Young Adult