{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:49:48Z","timestamp":1791560988406,"version":"4.3.4"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","funder":[{"name":"National Science and Technology Council","award":["110-2314-B-002-239"],"award-info":[{"award-number":["110-2314-B-002-239"]}]},{"name":"National Science and Technology Council","award":["111-2314-B-002-046"],"award-info":[{"award-number":["111-2314-B-002-046"]}]},{"name":"National Taiwan University Hospital","award":["UN110-030"],"award-info":[{"award-number":["UN110-030"]}],"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Ministry of Health and Welfare","award":["110-TDU-B-212-124005"],"award-info":[{"award-number":["110-TDU-B-212-124005"]}]},{"name":"Mrs. Hsiu-Chin Lee Kidney Research Foundation"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Primary aldosteronism patients on mineralocorticoid receptor antagonists face high cardio-renal risks, but evidence for effective add-on therapies remains limited.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Adding sodium-glucose cotransporter 2 inhibitors to mineralocorticoid receptor antagonists reduced 3-year mortality by 6.6%, major adverse cardiovascular events by 2.7%, and major adverse kidney events by 9.7% absolute risk.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Mineralocorticoid receptor antagonist-sodium-glucose cotransporter 2 inhibitor combination therapy offers a promising strategy to improve long-term survival and organ preservation in primary aldosteronism.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with primary aldosteronism (PA) are at an increased risk of cardiovascular and kidney complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have demonstrated protective effects in individuals at a high risk of cardiorenal events. This study investigates whether adding SGLT2is to mineralocorticoid receptor antagonists (MRAs) associates with better outcomes in patients with PA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed TriNetX data (February 1, 2014 to February 1, 2025) using an incident cohort design in adults with PA treated with MRAs within 3 months before or after PA diagnosis, excluding those who underwent adrenalectomy. Patients were divided into two cohorts based on initiation of an SGLT2i within 3 months of the PA diagnosis. The primary outcome was 3-year all-cause mortality; secondary outcomes included major adverse cardiovascular events and major adverse kidney events. We performed 1:1 propensity score matching and estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) using Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 24,074 patients with PA were included; 34% had comorbid diabetes, 26% had heart failure, and 2524 (11%) received SGLT2is. After a well-balanced propensity score matching, 2507 SGLT2i users were compared with 2507 nonusers. In the matched cohort, the incidence of all-cause mortality was 12% in SGLT2i users and 18% in nonusers. The combination of SGLT2i with MRA was associated with a lower risk of all-cause mortality (aHR, 0.59; 95% CI, 0.51 to 0.68; absolute risk reduction [ARR], 7%), major adverse cardiovascular event (aHR, 0.81; 95% CI, 0.69 to 0.94; ARR, 3%), and major adverse kidney event (aHR, 0.58; 95% CI, 0.52 to 0.65; ARR, 10%). Kaplan\u2013Meier survival curves for all outcomes demonstrated early divergence and remained distinct through the 3-year follow-up period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with PA, adding SGLT2is to MRAs is associated with lower mortality and cardiorenal complications. These associations offer a rationale for evaluation of this combined strategy to improve long-term outcomes in this high-risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.0000001144","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T17:01:23Z","timestamp":1785258083000},"page":"1772-1782","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Primary Aldosteronism"],"prefix":"10.2215","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8898-5538","authenticated-orcid":false,"given":"Li-Yang","family":"Chang","sequence":"first","affiliation":[{"name":"School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7752-3910","authenticated-orcid":false,"given":"Chieh","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3300-6700","authenticated-orcid":false,"given":"Ching-Chun","family":"Su","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Tainan Municipal Hospital, Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2859-5117","authenticated-orcid":false,"given":"Cheng-Hsuan","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6164-6655","authenticated-orcid":false,"given":"Che-Hsiung","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Taiwan"},{"name":"School of Medicine, Tzu Chi University, Hualien, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2109-1522","authenticated-orcid":false,"given":"Chun-Fu","family":"Lai","sequence":"additional","affiliation":[{"name":"Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7935-0991","authenticated-orcid":false,"given":"Vin-Cent","family":"Wu","sequence":"additional","affiliation":[{"name":"Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Taiwan Primary Aldosteronism Investigation (TAIPAI) study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"issue":"9","key":"B1-20261009","doi-asserted-by":"crossref","first-page":"2453","DOI":"10.1210\/clinem\/dgaf284","article-title":"Primary aldosteronism: an Endocrine Society Clinical Practice Guideline","volume":"110","author":"Adler","year":"2025","journal-title":"J Clin Endocrinol Metab."},{"issue":"5","key":"B2-20261009","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1210\/jc.2015-4061","article-title":"The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline","volume":"101","author":"Funder","year":"2016","journal-title":"J Clin Endocrinol 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