Elevated plasma aldosterone concentrations relate to renal impairment in Chinese southwestern people

Abstract

Background: Evidence on the biochemical phenotypes of primary aldosteronism and their link to renal function in Chinese populations is limited. This study explored the associations of plasma aldosterone concentration (PAC), plasma renin concentration (PRC), and the aldosterone-to-renin ratio (ARR) with renal function.

Methods: In this cross-sectional study of 1700 participants from Southwest China, associations between PAC, PRC, ARR, and renal parameters (serum creatinine [SCR], blood urea nitrogen [BUN], estimated glomerular filtration rate [eGFR]) were analyzed using a generalized linear mixed model. Dose-response relationships were assessed with P-trend and restricted cubic spline (RCS) analyses. A structural equation model evaluated the mediating effect of blood pressure.

Results: Higher log-transformed PAC was associated with elevated SCR (β = 0.451, 95% CI: 0.329, 0.573) and BUN (β = 0.370, 95% CI: 0.278, 0.462), and reduced eGFR (β = -0.263, 95% CI: -0.331, -0.194). RCS analyses confirmed linear dose-response relationships. These associations were more pronounced in males than females. Renin-Angiotensin-Aldosterone System (RAS) inhibitor use mitigated the positive association between PAC and BUN. Systolic blood pressure mediated a small proportion of the effect of PAC on SCR (2.4%) and eGFR (2.6%).

Conclusion: A continuous spectrum of PAC is associated with renal impairment in this Chinese cohort, with stronger effects observed in males. The use of RAS inhibitors may attenuate this aldosterone-related renal impairment.

Keywords: Aldosterone; blood pressure; eGFR; mediating effect; renal function.