Aldosterone-potassium ratio predicts primary aldosteronism subtype

Area of Science:

• Endocrinology
• Internal Medicine
• Nephrology

Background:

• Primary aldosteronism (PA) is a common cause of secondary hypertension.
• Accurate subtype diagnosis (unilateral vs. bilateral) is crucial for guiding treatment.
• Existing prediction models for PA subtypes often lack external validation.

Purpose of the Study:

• To develop and externally validate a simplified prediction score for unilateral and bilateral primary aldosteronism.
• To assess the utility of the aldosterone-to-lowest-potassium ratio (APR) in predicting PA subtypes.

Main Methods:

• A prediction model was developed using data from 165 Asian patients undergoing adrenal vein sampling (AVS).
• The model was validated in a European cohort of 97 patients from the SPARTACUS trial.
• Logistic regression identified key predictors, focusing on the APR.

Main Results:

• The simplified score, based on APR, demonstrated good predictive ability (AUC 0.80) in both development and validation cohorts.
• High APR values (>15) strongly predicted unilateral PA, while low values (<5) predicted bilateral PA.
• The APR score was more sensitive for identifying bilateral PA compared to other models.

Conclusions:

• The aldosterone-to-lowest-potassium ratio (APR) is a convenient and effective score for predicting primary aldosteronism subtypes across ethnicities.
• Utilizing APR can help identify patients likely to benefit from AVS, potentially leading to a more cost-effective management strategy.