Age-Related Cutoffs of Plasma Aldosterone/Renin Concentration for Primary Aldosteronism Screening

Abstract

Aim This retrospective study is aimed at investigating whether aldosterone-renin ratio (ARR) cutoffs calculated by the plasma aldosterone concentration (PAC)/plasma renin concentration (PRC) should be set differently in patients of different ages. Methods 521 hypertensive patients were screened for primary aldosteronism (PA) by the PAC/PRC. 174 patients diagnosed with PA and 311 patients with essential hypertension (EH) were included in the final analysis. Subjects were subdivided into four age groups: <40, 40–49, 50–59, and ≥60 years old. Results The accuracy of the ARR varied greatly among the different age groups. An ARR of 3.7 (ng/dl)/(μIU/ml) had a sensitivity of 100% and a specificity of 80% in patients ≥ 60 years old. With this cutoff, the sensitivities in patients < 40, 40–49, and 50–59 years old were 74%, 82%, and 87%, respectively, and the specificities were 94%, 95%, and 94%, respectively. To achieve a sensitivity higher than 90%, the ARR cutoff needed to be lowered to 2.0 (ng/dl)/(μIU/ml) for patients 40–49 and 50–59 years old, resulting in sensitivities of 90% and 95%, respectively, and specificities of 80% and 84%, respectively. To achieve a sensitivity higher than 90%, the ARR cutoff needed to be lowered to 1.0 (ng/dl)/(μIU/ml) for patients < 40 years old, resulting in a sensitivity of 90% and a specificity of 82%. Conclusions An ARR of 3.7 (ng/dl)/(μIU/ml) is optimal for patients ≥ 60 years; for patients 40–59 years, the optimal ARR cutoff is 2.0; for those younger than 40 years, an ARR of 1.0 may be more reasonable.

Primary aldosteronism: Higher volume load, cardiac output and arterial stiffness than in essential hypertension

“…The diagnosis of PA was based on screening and confirmatory testing [3]. Screening of aldosteronism (n = 130) was defined as serum aldosterone (pmol L À1 ) to plasma renin activity (ng mL À1 h À1 ) ratio > 750, with serum aldosterone concentration ≥ 280 pmol L À1 [3,19]; or serum aldosterone (pmol L À1 ) to plasma renin concentration (mU L À1 ) ratio > 30, with serum aldosterone concentration ≥ 280 pmol L À1 [3,20,21]. Most of the patients (n = 82) had presented with hypokalemia (Table 2), and confirmatory testing was performed in the majority (n = 113), showing urine aldosterone excretion > 33 nmol day À1 during oral sodium loading [3,19].…”

New advances in the diagnosis of primary aldosteronism

“…14 Later, after increasing the sample size, it was found that if the cutoff decreased to 1.0e2.0 (ng/dl)/ (uIU/ml), a higher sensitivity could be achieved. 15 Recently, Young from the Mayo Clinic reported that a PAC >10 ng/dl and a PRA <1.0 ng/ml/h or a PRC below detection levels is a better cutoff. 7 Based on data from the Chongqing Primary Aldosteronism Study (CONPASS), we found that a PAC/PRC ratio >1.0 (ng/ dl)/(uIU/ml) combined with a PAC >10 ng/dl, can achieve a diagnostic sensitivity of >90% (in press).…”

Comparison of the Chemiluminescence Immunoassay LIAISON® with the Radioimmunoassay for Aldosterone and Renin Measurement

“…Test of renin plasmatic activity is continuously replaced by concentration measurement only (Reincke et al, 2003;Ferrari et al, 2004). Optimization of the ratio for screening purposes is being studied ( Jensen et al, 2014;Ma et al, 2018;Russmann et al, 2019). Till now none widely used optimized ratio calculation is known.…”