Endocrine Abstracts

Introduction: This study investigated the independent and combined effects of baseline and longitudinal changes in serum cortisol and aldosterone levels on the risk and progression of hypertensive nephropathy in patients with essential hypertension.

Methodology: A prospective cohort study was conducted at Khyber Teaching Hospital, Peshawar, from January 2022 to December 2023, with 190 adults aged 30-70 years who had essential hypertension and preserved renal function at baseline without any secondary causes for CKD. Fasting blood samples for cortisol and Aldosterone levels were collected between 8:00 and 9:00 AM at baseline, 12 months, and 24 months (using immunoassays CLIA). Renal functions were monitored using serum creatinine, eGFR , and urine PCR, with hypertensive nephropathy defined per KDIGO criteria. Statistical analyses were performed using SPSS v26.0, employing Kaplan-Meier curves and Cox proportional hazards models adjusted for potential confounders. Hormonal interactions were evaluated using multiplicative and additive terms, and repeated-measures ANOVA and regression models assessed hormone trajectories over time.

Results: Over a median follow-up of 24 months, 43 patients (22.6%) developed hypertensive nephropathy. The absolute risk of nephropathy was substantially higher among those in the highest tertiles of both cortisol and aldosterone (34.4%) compared to those in the lowest tertiles (11.2%). Elevated baseline cortisol levels were independently associated with increased risk of nephropathy (hazard ratio [HR]: 2.31; 95% confidence interval [CI]: 1.29-4.13; P = 0.005). Similarly, elevated aldosterone levels were independently associated with risk (HR: 1.97; 95% CI: 1.11-3.50; P = 0.021). There was a significant interaction between cortisol and aldosterone levels (P = 0.038), indicating a synergistic effect on the risk of nephropathy.

Conclusion: Both elevated and increasing serum cortisol and aldosterone levels independently and synergistically predict the development of hypertensive nephropathy. It is suggested that incorporating hormonal profiling into early risk stratification models may enhance identification of hypertensive patients at risk for kidney damage.