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Subclinical Primary Aldosteronism and eGFR Decline Over Time
Gregory L Hundemer1,2, Louis-Charles Desbiens3, Mohsen Agharazii4,5
1Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Journal of the American Society of Nephrology : JASN
|February 13, 2026
Summary
Subclinical primary aldosteronism, indicated by elevated aldosterone-to-renin ratio (ARR), is linked to faster kidney function decline. Lower renin levels also correlate with increased estimated glomerular filtration rate (eGFR) decline, independent of blood pressure.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Research
Background:
- Primary aldosteronism accelerates kidney function decline.
- Subclinical forms of primary aldosteronism are common but their impact on kidney function is unknown.
Purpose of the Study:
- To investigate the association between subclinical primary aldosteronism markers and estimated glomerular filtration rate (eGFR) decline.
Main Methods:
- Prospective cohort study of 976 Canadian adults (40-69 years).
- Measured aldosterone, renin, creatinine, and cystatin C.
- Used multivariable linear mixed regression to assess associations of aldosterone, renin, and aldosterone-to-renin ratio (ARR) with eGFR decline over 5-7 years.
Main Results:
- Higher ARR was associated with a 11% steeper eGFR decline over time.
- Lower renin levels were associated with a 16% steeper eGFR decline over time.
- Aldosterone alone showed no significant association with eGFR change.
Conclusions:
- Elevated ARR and suppressed renin are independently associated with accelerated eGFR decline.
- These associations persist regardless of blood pressure levels.
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