Unilateral Adrenalectomy for Primary Aldosteronism Linked to CKD, Gout Risks

A study found that patients with primary aldosteronism who undergo unilateral adrenalectomy are at an increased long-term risk of chronic kidney disease (CKD) and gout.1

To address gaps in knowledge about the long-term renal and metabolic effects of unilateral adrenalectomy, study investigator Chu-Wen Fang, from Changhua Christian Hospital in Taiwan, and colleagues conducted a study with over 537 patients diagnosed with primary aldosteronism between 2000 and 2019 to assess outcomes. Primary outcomes included new-onset CKD/renal impairment, hyperuricemia, and gout.

The team used the Longitudinal Generation Tracking Database from the Health and Welfare Data Science Center in Taiwan to collect participants; the study excluded those with adrenal insufficiency or pre-existing hyperuricemia, gout, CKD, or plasma cell dyscrasia. The study also included a control arm (n = 2148), matched 4:1 using propensity scores based on age, gender, and comorbidities.

Compared with controls, participants undergoing unilateral adrenalectomy had a significantly increased risk of CKD or renal impairment (adjusted hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.58 – 2.72; P <.0001) and gout (aHR, 1.54; 95% CI, 1.02 – 2.32; P =.048). The study also revealed that participants undergoing adrenalectomy had an increased risk of hyperuricemia, but this did not reach statistical significance (aHR, 1.92; 95% CI, 0.82 – 4.52; P =.424).1

Kaplan-Meier curves revealed that, over 20 years, patients who underwent adrenalectomy experienced a greater cumulative incidence of CKD and gout. As for hyperuricemia, differences in incidence between groups were comparatively modest.1

Stratified analyses identified distinct age- and sex-related risk patterns. Older adults and male patients undergoing adrenalectomy were at a greater risk for postoperative CKD and hyperuricemia. Middle-aged adults (45 – 54 years) and women had a greater risk of gout following surgery. Patients who required ongoing or intensified antihypertensive therapy after adrenalectomy demonstrated a substantially elevated risk of CKD and gout.1

“These findings underscore the need for vigilant renal and metabolic monitoring postoperatively, particularly in older patients and those with predisposing comorbidities,” investigators wrote.1

Other Research in Primary Aldosteronism

Clinicians must account for the risks of gout and CKD in patients receiving unilateral adrenalectomy, and current research is examining new options to improve outcomes.

“Recommended therapies for primary aldosteronism have changed little over the past several decades and are completely effective in only a minority of patients,” wrote investigators of the phase 2a SPARK trial.2

The New England Journal of Medicine published the results of the SPARK trial in July 2025, which showed the promise of baxdrostat, a highly selective, second-generation, nonimidazole aldosterone synthase inhibitor, for patients with primary aldosteronism.2 Participants received baxdrostat 2 mg daily for 4 weeks, after which the dose was increased monthly to 4 or 8 mg per day based on blood pressure measurements and the absence of unacceptable adverse events.2

At week 12, all 15 patients had reduced systolic blood pressure (mean reduction, 24.9 mm Hg; 95% CI, 19.0 to 30.8). Participants also had reduced diastolic blood pressure (mean reduction, 10.6±9.0 mm Hg), plasma aldosterone-to-renin ratio (median reduction, 97.3%), plasma levels (mean reduction, 90.9%), and 24-hour urinary aldosterone levels (mean reduction, 91.6%).2

Aside from baxdrostat, investigators have identified a new target for primary aldosteronism treatment: renin levels.3

A study published in The Lancet Diabetes & Endocrinology and led by Sho Katsuragawa, from Monash University, PhD candidate, was the first to comprehensively synthesize data on the association between post-treatment renin levels and a broad range of clinical outcomes in primary aldosteronism. The investigators found that patients whose renin levels normalized after initiating a mineralocorticoid receptor antagonist (MRA) had a significantly lower risk of cardiovascular events and death compared with those whose renin remained suppressed.3

“It supports current expert recommendations that renin normalization should be achieved by up-titrating MRA in medical management for PA, especially in a cardiovascular protection perspective,” Katsuragawa said in a statement.3

References

1. Fang CW, Muo CH, Wu SC. Chronic kidney disease, hyperuricemia, and gout after adrenalectomy for primary aldosteronism: a 20-year population-based study. J Endocrinol Invest. Published online December 3, 2025. doi:10.1007/s40618-025-02762-7

2. Brooks A. Phase 2a Baxdrostat Data Show Promise for Primary Aldosteronism. HCPLive. Published July 14, 2025. Accessed December 11, 2025. https://www.hcplive.com/view/phase-2a-baxdrostat-data-show-promise-for-primary-aldosteronism.

3. New Primary Aldosteronism treatment target identified. Hudson Institute of Medical Research. Published November 19, 2025. Accessed December 11, 2025. https://hudson.org.au/news/new-primary-aldosteronism-treatment-target-identified/