Ashish Verma, MD Assistant Professor, Nephrology Department of Medicine Boston University

Increased Adrenal Hormone Aldosterone Linked to Greater Risk of Chronic Kidney Disease Interview with:

Ashish Verma, MD Assistant Professor, Nephrology Department of Medicine Boston University

Dr. Verma

Ashish Verma, MD
Assistant Professor, Nephrology
Department of Medicine
Boston University What is the background for this study? Would you tell us a little about aldosterone?

Response: “Recent randomized, controlled trials have shown that a drug called finerenone is effective in delaying CKD progression and adverse cardiovascular outcomes in patients with chronic kidney disease and diabetes. However, the role of aldosterone in this process was not directly investigated and levels of the hormone were not measured,”

“Since excessive levels of aldosterone is common, yet mostly unrecognized, we hypothesized that one reason why finerenone was effective in lowering the risk of CKD progression was that it was treating unrecognized high concentrations of the hormone.”

To study this we investigated the associations between aldosterone concentrations in the blood and kidney disease progression among 3680 participants in the Chronic Renal Insufficiency Cohort study, which ran in seven clinics in the US between 2003 and 2008. The participants were aged between 21 and 74 years old.

Aldosterone is a steroid hormone secreted by the adrenal glands, which sit above the kidneys. Its main role is to regulate salt and water in the body, and so it plays a central role in controlling blood pressure. Too much of it can lead to high blood pressure, cardiovascular and kidney diseases. What are the main findings?

Response:  After adjusting for factors that could affect the results, such as medications, other medical conditions, age, race, height and weight, they found that each doubling of aldosterone concentrations in the blood was linked to an 11% increased risk of CKD progression. Patients with concentrations in the top 25% of the group had a 45% increased risk compared to the 25% of patients with the lowest aldosterone concentrations. The risk was similar regardless of whether or not patients also had diabetes. What should readers take away from your report?

Response: “These findings are important as they suggest that higher concentrations of aldosterone may play a role in CKD progression and cardiovascular disease in patients with CKD. This study provides evidence for the mechanism by which mineralocorticoid receptor antagonists could delay CKD progression and supports investigating their value in patients without diabetes.” What recommendations do you have for future research as a results of this study?

Response: The Food and Drug Administration (FDA) in the US has approved the use of finerenone for patients with CKD and diabetes. Now a randomised controlled clinical trial is investigating the efficacy and safety of finerenone in non-diabetic CKD patients. “This trial will play an important role in answering the question, whether MR antagonist therapy will be useful in delaying CKD progression in patients with CKD and without diabetes

Nothing to disclose


“Aldosterone in chronic kidney disease and renal outcomes”, by Ashish Verma et al. European Heart Journal. doi:10.1093/eurheartj/ehac352

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Last Updated on August 10, 2022 by Marie Benz MD FAAD