{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T15:01:25Z","timestamp":1764687685778},"reference-count":36,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2015,9,6]],"date-time":"2015-09-06T00:00:00Z","timestamp":1441497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"ERA-EDTA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Plasma aldosterone is markedly increased in end stage renal disease (<jats:styled-content style=\"fixed-case\">ESRD<\/jats:styled-content>). The relationship between aldosterone, all\u2010cause and cardiovascular (<jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content>) mortality in observational studies performed so far is controversial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>We investigated the relationship between aldosterone, mortality and <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> events in multivariate analyses including nutrition status, inflammation, <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content> function and fluids volume biomarkers in 278 <jats:styled-content style=\"fixed-case\">ESRD<\/jats:styled-content> patients without heart failure at baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In univariate analyses aldosterone was an inverse predictor of death (3rd tertile vs. 1st tertile Hazard ratios (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>): 0\u00b758; 95% confidence interval (CI) 0\u00b738\u20130\u00b790. <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b701) and <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> events (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>: 0\u00b763; 95% CI 0\u00b741\u20130\u00b796; <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b703). Data adjustment for inflammation and malnutrition biomarkers substantially reduced the inverse relationship between aldosterone, mortality and <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> events to be largely not significant (<jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b731 and <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b736, respectively). The same was true by adjusting for volume expansion and <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content> dysfunction (left atrial volume and atrial natriuretic peptide) biomarkers (<jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b730 for both outcomes). In a model adjusting for the full set of biomarkers of protein energy wasting\/inflammation and volume expansion\/<jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content> dysfunction the inverse relationship between aldosterone and death and <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> events was nullified (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> for death 0\u00b798, <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b793; <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> for <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> events 0\u00b796, <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b787).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Aldosterone is an inverse predictor of mortality and <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> events in <jats:styled-content style=\"fixed-case\">ESRD<\/jats:styled-content> patients. This seemingly paradoxical relationship is abolished by statistical adjustment for inflammation, protein energy malnutrition, and volume expansion biomarkers indicating that it is the mere expression of the confounding effect of these factors. A clinical trial is needed to establish if aldosterone antagonism may improve clinical outcomes in <jats:styled-content style=\"fixed-case\">ESRD<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.12509","type":"journal-article","created":{"date-parts":[[2015,9,7]],"date-time":"2015-09-07T05:07:09Z","timestamp":1441602429000},"page":"1077-1086","source":"Crossref","is-referenced-by-count":9,"title":["Aldosterone, mortality, cardiovascular events and reverse epidemiology in end stage renal disease"],"prefix":"10.1111","volume":"45","author":[{"given":"Samar","family":"Abd ElHafeez","sequence":"first","affiliation":[{"name":"Department of Epidemiology High Institute of Public Health Alexandria University Alexandria Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Tripepi","sequence":"additional","affiliation":[{"name":"CNR \u2013 IFC\/IBIM Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension Reggio Calabria Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Mallamaci","sequence":"additional","affiliation":[{"name":"CNR \u2013 IFC\/IBIM Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension Reggio Calabria Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmine","family":"Zoccali","sequence":"additional","affiliation":[{"name":"CNR \u2013 IFC\/IBIM Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension Reggio Calabria 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