Context: The association between KCNJ5 somatic mutations and long-term outcomes in patients with operated unilateral primary aldosteronism (uPA) is unclear.
Objective: To evaluate associations among KCNJ5 somatic mutations, clinical characteristics, incident long-term cardiovascular events, and all-cause mortality in uPA patients after adrenalectomy in a large longitudinal population study.
Methods: We enrolled uPA patients from the Taiwan Primary Aldosteronism Investigation database who had undergone adrenalectomy between 2013 and 2017 and followed them until 2020. The outcomes were achieving complete clinical success at 1 year after adrenalectomy, long-term major adverse cardiac and cerebrovascular events (MACCEs), and mortality.
Results: Of the 358 enrolled patients (46.7% men; mean age, 51.3 years), 188 (52.5%) harbored KCNJ5 somatic mutations. The baseline characteristics of younger age [odds ratio (OR)=2.44; P=0.001], lower body mass index (OR=2.04; P=0.005), lower potassium (OR=6.55; P<0.001), and larger tumor size (OR=2.05; P=0.023) were potential predictors of KCNJ5 somatic mutations. The operated uPA patients harboring KCNJ5 somatic mutations were associated with a higher likelihood of complete clinical success at 1 year after adrenalectomy (OR=1.98; P=0.016). KCNJ5 somatic mutation carriers [hazard ratio (HR)=0.46; P=0.044), those with a shorter duration of hypertension (HR=1.05; P=0.008), and those who achieved complete clinical success (HR=0.49; P=0.036) had a lower risk of MACCEs and mortality.
Conclusion: Operated uPA patients harboring KCNJ5 somatic mutations had a lower risk of long-term MACCEs and mortality after adrenalectomy. However, better long-term outcomes in the operated uPA patients harboring KCNJ5 somatic mutations were attenuated in those with baseline lower potassium levels, shorter duration of hypertension, obesity, higher estimated glomerular filtration rate, and residual hypertension after adrenalectomy.
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KCNJ5 Somatic Mutations are Associated with Better Long-Term Outcomes in Patients with Unilateral Primary Aldosteronism.
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January 2025
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
Context: The association between KCNJ5 somatic mutations and long-term outcomes in patients with operated unilateral primary aldosteronism (uPA) is unclear.
Objective: To evaluate associations among KCNJ5 somatic mutations, clinical characteristics, incident long-term cardiovascular events, and all-cause mortality in uPA patients after adrenalectomy in a large longitudinal population study.
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Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
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Article Synopsis
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[Research progress of KCNJ5 gene in aldosterone-producing adenoma].
Sheng Li Xue Bao
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Department of Internal Medicine, School of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China.
Aldosterone-producing adenoma is a subtype of primary aldosteronism. Recent advancements in multi-omics research have led to significant progress in understanding primary aldosteronism at the genetic level. Among the various genes associated with the development of aldosterone-producing adenomas, the KCNJ5 (potassium inwardly rectifying channel, subfamily J, member 5) gene has received considerable attention due to its prevalence as the most common somatic mutation gene in primary aldosteronism.
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