Aldosterone
It plays a key role in maintaining blood pressure and fluid balance.
Aldostrone's effects include increasing sodium reabsoprtion and potassium excretion in the kidneys, as well as promoting water retention.
Dysregulation of aldosterone levels can contribute to conditions like hypertension, congestive heart failure, and kidney disease.
Accurate measurement and analysis of aldosterone levels is important for diagnosing and managing these related disorders.
Most cited protocols related to «Aldosterone»
Most recents protocols related to «Aldosterone»
Example 8
In this example, research shows that during the mass spectrometric detection of the 5 markers, the cationic mode should be chosen to detect angiotensin I, angiotensin II, cortisol and 18-hydrocorticosterone, while the anionic mode needs to be chosen to detect aldosterone; this is because when the cationic mode is chosen, there exists a peak diagram of cortisone, an isomer of aldosterone, nearby the detection peak of aldosterone to cause larger interference, and CV % is greater than 15%; but when the anionic mode is applied for detection, the test result is more stable and accurate, and CV% is less than 8.33%.
The proportion of patients still on RAASi at the end of the first month is specified for both arms and based on OPAL-HK trial data. For the patiromer arm, this proportion relates only to those that have achieved response, with the remaining patients assumed to be receiving RAASi therapy in line with the SoC arm. Rates of RAASi discontinuation and down-titration are taken from the OPAL-HK trial for months 2 and 3 [43 ]. From month 4 onwards, potassium level dependent RAASi discontinuation and down-titration rates were taken from Linde et al. (2019) and applied to the SoC arm [23 (link)]. Hazard ratios relating to reduced (or increased) rates of discontinuation/down-titration in those receiving patiromer in subsequent months were obtained from the OPAL-HK trial and applied to the rates from Linde et al. (2019). To reflect the impermanent nature of RAASi treatment changes in clinical practice, patients could return to optimal RAASi use independent of their potassium level with a monthly probability of 3.51% [23 (link)]. Due to a lack of relevant data, patients who down-titrated RAASi use were assumed to not return to maximum use. RAASi discontinuation and down-titration rates are summarised in Table
RAASi discontinuation, down-titration and up-titration, by potassium category
34.438% (6.589%) | 3.336% (2.421%) | 35.549% (6.589%) | 0.000% (0.000%) | 34.438% (6.589%) | 3.336% (2.421%) | OPAL-HK [43 ] | |
| 2.600% (0.009%) | 0.181% | 1.800% (0.026%) | 1.800% | 2.600% (0.009%) | 0.181% | Linde et al. (2019) [23 (link)] |
| 3.029% (0.102%) | 0.211% | 2.617% (0.102%) | 2.617% | 3.029% (0.102%) | 0.211% | |
| 4.547% (0.230%) | 0.319% | 5.306% (0.230%) | 5.306% | 4.547% (0.230%) | 0.319% | |
| 10.000% (0.663%) | 0.721% | 8.900% (0.638%) | 8.900% | 10.000% (0.663%) | 0.721% |
RAASi Renin–angiotensin–aldosterone system inhibitor, K + Potassium, SE Standard error, SoC Standard of care
Note: Complete derivation described further in Supplemental Appendix
HK incidence
Time applied | Potassium level | Monthly probability | Source | |||
---|---|---|---|---|---|---|
Month 1 | K + > 5 to ≤ 5.5 | 21.13% | 3.32% | 21.13% | 3.32% | OPAL-HK CSR; distributed across threshold categories in line with published data [43 , 46 (link)] |
K + > 5.5 to ≤ 6 | 1.66% | 1.04% | 1.66% | 1.04% | ||
K + > 6 | 0.38% | 0.50% | 0.38% | 0.50% | ||
Month 2 & 3 | K + > 5 to ≤ 5.5 | 14.00% | 4.68% | 15.00% | 4.81% | OPAL-HK CSR [43 ] |
K + > 5.5 to ≤ 6 | 6.10% | 3.23% | 25.22% | 5.86% | ||
K + > 6 | 1.40% | 1.58% | 5.78% | 3.15% | ||
Subsequent monthsa | K + > 5 to ≤ 5.5 | 0.543% | 0.054% | 1.158% | 0.116% | Horne et al. (2019); 'OPAL-HK CSR [43 , 46 (link)] |
K + > 5.5 to ≤ 6 | 0.022% | 0.002% | 0.092% | 0.009% | ||
K + > 6 | 0.005% | 0.001% | 0.021% | 0.002% |
HK Hyperkalaemia, RAASi Renin–angiotensin–aldosterone system inhibitor, SE Standard error, SoC Standard of care
aSoC probabilities informed by HK recurrence rates observed in Horne et al. (2019) with recurrence events distributed in line with the distribution of initial HK events across potassium categories; patiromer estimates informed by Horne et al. (2019) after application of a HR based on OPAL-HK data from months 2 and 3; SE assumed as 10% of mean
Influence of RAASi use and HK events on disease progression and events. References below each box describe the baseline probabilities/rates; references alongside arrows describe the influence of one disease component on the other, with influences applied to the baseline probabilities rates
Among all the RAS patients, 3209 (83.0%) were with atherosclerosis, 366 (9.5%) were with Takayasu disease and 46 (1.2%) were with other conditions. The remaining 245 (6.3%) patients met the diagnostic criteria for FMD and were subsequently included in the study.
All patients underwent a detailed investigation, including demographic characteristics (age, sex, height and ethnicity), clinical characteristics (office BP, smoking, family history of hypertension or FMD, concomitant diseases, current medications, age at diagnosis of FMD, an angiographic subtype of FMD, symptoms of FMD at diagnosis and associated atheroma lesions), biochemical sampling (plasma aldosterone, plasma renin activity), Doppler ultrasonography of carotid arteries, magnetic resonance angiography (MRA) of the intracranial artery and CTA or MRA of the abdominal and renal artery. All patients diagnosed with FMD underwent catheter-based angiography and balloon angioplasty to treat renovascular hypertension, and stent implantation should not be performed unless balloon angioplasty was failed.
The ethics committees of Fuwai Hospital, National Center for Cardiovascular Disease in Beijing and Ruijin Hospital, Shanghai Jiao Tong University School of Medicine in Shanghai approved their cohort study protocol, respectively. All participants gave written informed consent. The study was conducted in accordance with the Declaration of Helsinki.