Kidney Week

Abstract: SA-PO532

Subclinical Primary Aldosteronism and eGFR Decline

Session Information

• Hypertension and CVD: Clinical - II
  November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Hundemer, Gregory L., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Gregory L. Hundemer,

• Agharazii, Mohsen, Universite Laval, Quebec, Quebec, Canada

Mohsen Agharazii,

• Madore, Francois, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada

Francois Madore,

• Goupil, Remi, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada

Remi Goupil,

Background

Primary aldosteronism (PA), characterized by renin-independent aldosterone secretion, is the most common and modifiable form of secondary hypertension. Overt PA predisposes to disproportionately high rates of cardiovascular and kidney disease, independent of blood pressure (BP). Growing evidence suggests that milder forms of renin-independent aldosteronism (ie, Subclinical PA) are highly prevalent yet their clinical significance remains uncertain.

Methods

Prospective study of 536 participants aged 40-69 yr and on no BP medications from the randomly sampled, population-based CARTaGENE cohort (Canada). Using aldosterone and renin levels from enrollment, we employed multivariable linear regression models to measure the association between the aldosterone-renin ratio (ARR) and eGFR (via the 2021 CKD-EPI_Cr/CysC equation) measured at enrollment and after 5-7 years of follow-up.

Results

The mean (SD) age, eGFR, and systolic BP were 55 (7) years, 107 (13) mL/min/1.73m², and 132 (11) mmHg, respectively. Higher ARR was successively associated with steeper annual eGFR decline with ARR Tertile 3 having a 74% steeper decline than ARR Tertile 1 (1.18 vs. 0.68 mL/min/1.73m²/yr, P=0.01; Fig. 1). On multivariable linear regression, higher ARR was associated with steeper annual eGFR decline (P=0.03; Fig. 2).

Conclusion

In a randomly sampled, population-based cohort of individuals on no antihypertensive medication, Subclinical PA was associated with steeper eGFR decline, independent of BP. Subclinical PA may serve as a potentially modifiable risk factor to prevent or slow CKD.