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Clinical and biochemical outcomes after adrenalectomy for primary aldosteronism in tertiary and quaternary referral centers: data from SOPRANO study

Hypertension Research volume 47, pages 721–734 (2024)Cite this article

Abstract

Hypertension cure following adrenalectomy in unilateral primary aldosteronism (PA) remains uncertain. Previous meta-analyses have shown highly variable surgical outcomes. Our study aimed to determine the unknown proportion of complete clinical and biochemical success in tertiary and quaternary referral centers. We conducted a systematic review and meta-analysis of studies reporting surgical outcomes of unilateral PA patients within the Surgical Outcome of PRimary Aldosteronism progNostic mOdels (SOPRANO) study. From 27 publications we identified 32 eligible studies, of which 22 were judged to be at low risk of bias. Eighteen were single-center studies, while fourteen were multi-center studies, with patients recruited from 132 referral centers worldwide. Adrenalectomy was performed on 5887 patients, with 4861 (83%) included in the final analysis. The pooled estimates of complete clinical and biochemical success for all studies were 39% (95% CI: 34–44%) and 99% (95% CI: 96–99%), respectively, similar to that found for studies at low risk of bias. Multivariate meta-regression analyses for all studies and low-bias risk studies revealed that BMI (P < 0.01), recruitment time period (P < 0.01), and hypertension duration (P < 0.05) inversely correlated with complete clinical success, while BMI (P < 0.05) and the number of enrolled centers (P < 0.05) inversely correlated with complete biochemical success. In summary, our findings offer robust estimates of complete clinical and biochemical success rates following adrenalectomy for unilateral PA in tertiary and quaternary referral centers and identify new potential effect modifiers that can help clinicians to inform and counsel patients about post-surgery expectations, guaranteeing effective treatment and ultimately enhancing outcomes.

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The data used for the work are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank all principal investigators who have replied to our inquiries and/or provided us with further information or data concerning their publications. Their help enabled us to include as many studies as possible in analysis. We want to thank Hironobu Umakoshi, Hoi-Tik Leung, Jacopo Burrello, Jinbo Hu, Ludwig Pasquier, Marta Araujo-Castro, Shingo Hatakeyama, Takanobu Utsumi, Xiaoqun He, and Yu-chao Huang-Fu.

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Authors and Affiliations

  1. Centro per lo Studio e la Cura dell’Ipertensione Arteriosa, Internal Medicine Unit, San Bortolo Hospital, U.L.S.S. 8 Berica, Vicenza, Italy

    Luigi Marzano

  2. Internal Medicine Unit, San Bortolo Hospital, U.L.S.S. 8 Berica, 36100, Vicenza, Italy

    Luigi Marzano

  3. Department of Medicine (DIMED), University of Padova, 35128, Padova, Italy

    Claudio Ronco

  4. Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, 36100, Vicenza, Italy

    Claudio Ronco

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  1. Luigi Marzano
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Concept and design of the study: LM, CR. Literature research and clinical advice: LM, CR. Acquisition, analyses, or interpretation of data: LM. Manuscript drafting: LM. Critical revision of the manuscript for important intellectual content: LM, CR. Study supervision: LM, CR.

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Correspondence to Luigi Marzano.

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Marzano, L., Ronco, C. Clinical and biochemical outcomes after adrenalectomy for primary aldosteronism in tertiary and quaternary referral centers: data from SOPRANO study. Hypertens Res 47, 721–734 (2024). https://doi.org/10.1038/s41440-023-01554-x

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