Aldosterone and glomerular filtration--observations in the general population

Abstract

Background: Increasing evidence suggests that aldosterone promotes renal damage. Since data on the association between aldosterone and renal function in the general population are sparse, we chose to address this issue. We investigated the associations between the plasma aldosterone concentration (PAC) or the aldosterone-to-renin ratio (ARR) and the estimated glomerular filtration rate (eGFR) in a sample of adult men and women from Northeast Germany.

Methods: A study population of 1921 adult men and women who participated in the first follow-up of the Study of Health in Pomerania was selected. None of the subjects used drugs that alter PAC or ARR. The eGFR was calculated according to the four-variable Modification of Diet in Renal Disease formula. Chronic kidney disease (CKD) was defined as an eGFR < 60 ml/min/1.73 m2.

Results: Linear regression models, adjusted for sex, age, waist circumference, diabetes mellitus, smoking status, systolic and diastolic blood pressures, serum triglyceride concentrations and time of blood sampling revealed inverse associations of PAC or ARR with eGFR (ß-coefficient for log-transformed PAC -3.12, p < 0.001; ß-coefficient for log-transformed ARR -3.36, p < 0.001). Logistic regression models revealed increased odds for CKD with increasing PAC (odds ratio for a one standard deviation increase in PAC: 1.35, 95% confidence interval: 1.06-1.71). There was no statistically significant association between ARR and CKD.

Conclusion: Our study demonstrates that PAC and ARR are inversely associated with the glomerular filtration rate in the general population.

Figure 1

Adjusted mean eGFR according to sex-specific tertiles of PAC or ARR in 1921 SHIP-1 participants. PAC, plasma aldosterone concentration; ARR, aldosterone-to-renin ratio. The multivariable analysis of variance models were adjusted for age, sex, waist circumference, systolic and diastolic blood pressures, diabetes mellitus, smoking status, serum triglyceride concentrations, time of blood sampling, and additionally plasma renin concentration in models with PAC or ARR as independent variables. The estimated glomerular filtration rate (eGFR) was calculated according to the four-variable Modification of Diet in Renal Diseases formula.