Unilateral Adrenalectomy Raises Long-Term CKD and Gout Risk in Primary Aldosteronism: Study
Taiwan: A 20-year population study has revealed that patients with primary aldosteronism who undergo unilateral adrenalectomy face increased long-term risks of chronic kidney disease (CKD) and gout, with older adults and males particularly affected. Additionally, the SPARK trial highlighted baxdrostat’s promising ability to lower blood pressure and aldosterone levels in primary aldosteronism patients.
The study published in the Journal of Endocrinological Investigation by Chu-Wen Fang from the Graduate Institute of Clinical Medicine, National Taiwan University, and colleagues, offers important insights into the renal and metabolic consequences that may follow adrenalectomy in primary aldosteronism (PA). While unilateral adrenalectomy is widely regarded as a curative therapy for hormonally driven hypertension, its long-term systemic impact has not been well understood.
The population-based research aimed to bridge that gap by exploring the incidence and risk patterns of CKD, renal impairment, hyperuricemia, and gout in comparison with matched individuals without surgery.
Using Taiwan’s Longitudinal Generation Tracking Database, which follows nearly two million insured individuals, the researchers identified 1,110 patients diagnosed with PA between 2000 and 2019. After excluding individuals with pre-existing renal disease, gout, hyperuricemia, adrenal insufficiency, or related disorders, 537 patients who had undergone unilateral adrenalectomy formed the primary study group.
For comparison, the team created a control cohort four times larger—2,148 individuals—matched by age, sex, and comorbidities through propensity scoring. The investigators then assessed postoperative outcomes using Cox proportional hazards modelling and tracked cumulative incidence through Kaplan–Meier analysis.
The results revealed clear postoperative vulnerabilities:
- Adrenalectomy patients had more than double the risk of developing CKD or renal impairment compared with matched controls (aHR 2.07).
- The risk of gout was significantly higher in the adrenalectomy group (aHR 1.54).
- Although hyperuricemia showed an increased trend post-adrenalectomy, the association was not statistically significant.
- Kaplan–Meier analysis demonstrated a higher cumulative incidence of CKD and gout over the 20-year follow-up in the adrenalectomy group, indicating progressive long-term risk.
- Older adults and male patients were more vulnerable to postoperative CKD and metabolic complications.
- Middle-aged individuals (particularly ages 45–54) and women experienced a notable increase in gout incidence after surgery.
- Continued or increased use of antihypertensive medications following adrenalectomy was strongly linked to higher risks of both CKD and gout, emphasizing the role of postoperative blood pressure management.
According to the authors, metabolic comorbidities and advancing age emerged as major predictors of adverse renal and metabolic outcomes after adrenalectomy. These findings emphasize the need for clinicians to adopt long-term monitoring strategies that include renal function assessment, uric acid evaluation, and personalized blood pressure management in patients treated surgically for PA.
"Overall, this nationwide analysis sheds light on a previously underrecognized postoperative burden and highlights the importance of proactive, lifelong follow-up care for individuals undergoing adrenalectomy for primary aldosteronism," the authors concluded.
Reference:
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 (2025). https://doi.org/10.1007/s40618-025-02762-7
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