The Association between eGFR and the Aldosterone-to-Renin Ratio and Its Effect on Screening for Primary Aldosteronism
The Association between eGFR and the Aldosterone-to-Renin Ratio and Its Effect on Screening for Primary Aldosteronism
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eGFR 与醛固酮肾素比值的关联及其对原发性醛固酮增多症筛查的影响
DOI：
10.1155/2020/2639813
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发表时间：
2020-02-07
影响因子：
2.8
通讯作者：
Li, Xiaoying
中科院分区：
文献类型：
--
作者：
Xu, Jing;Yang, Yumei;Li, Xiaoying
目的原发性醛固酮增多症（PA）患者长期暴露于肾上腺分泌过多的醛固酮可引起肾损害。肾功能可能会显著影响醛固酮与肾素比值（ARR），尤其是在长期PA相关的肾损害患者中。本研究的目的是探讨估计肾小球滤过率（eGFR）和ARR之间的关系及其对PA筛查的影响。方法本研究在复旦大学附属中山医院完成。从2012年至2015年连续招募了803例高血压患者。所有参与者进行常规生化检测，包括血浆肾素活性（PRA）和血浆醛固酮浓度（PAC）。在PAC高于10 ng/dl的所有患者中，进行盐水灌注试验，如果需要，还进行CT扫描或肾上腺静脉采样。分别对eGFR < 90和eGFR ≥ 90组进行受试者工作特征（ROC）分析，以确定ARR的最佳截断值。结果PA的最佳截断点为：在整个人群中，ARR为40 ng/dl/ng/ml. h;在eGFR高于90 ml/min/1.73 m2的受试者中，ARR为52 ng/dl/ng/ml. h;在eGFR低于90 ml/min/1.73 m2的受试者中，ARR为18 ng/dl/ng/ml. h。eGFR > 90 ml/min/1.73 m2的患者PRA水平显著低于eGFR < 90 ml/min/1.73 m2的患者（P < 0.05），ARR水平显著高于eGFR < 90 ml/min/1.73 m2的患者（P < 0.05）。结论原发性醛固酮增多症患者中未受抑制的肾素和较低的ARR水平与eGFR降低相关。通过分层eGFR的ARR诊断标准可能是筛查原发性醛固酮增多症的最佳策略。
Objectives Long-term exposure to excessive aldosterone secretion from the adrenal gland may cause renal damage in patients with primary aldosteronism (PA). The aldosterone-to-renin ratio (ARR) may be significantly affected by renal function, especially in patients with renal damage related to long-term PA. The objective of this study was to investigate the association between the estimated glomerular filtration rate (eGFR) and ARR as well as its effect on screening for PA. Methods This study was performed in Zhongshan Hospital, Fudan University, China. 803 patients with hypertension were consecutively recruited from 2012 to 2015. All participants underwent routine biochemical measurements, including plasma renin activity (PRA) and plasma aldosterone concentration (PAC). In all patients with a PAC higher than 10 ng/dl, a saline perfusion test was conducted, and a CT scan or adrenal venous sampling was also performed if needed. Receiver operating characteristic (ROC) analysis was conducted in all eGFR < 90 and eGFR ≥ 90 groups separately to determine the optimal cut-off values of ARR. Results The optimal cut-off point for PA was an ARR of 40 ng/dl per ng/ml.h in the whole population, 52 ng/dl per ng/ml.h in subjects with an eGFR higher than 90 ml/min/1.73 m2, and 18 ng/dl per ng/ml.h in subjects with an eGFR lower than 90 ml/min/1.73 m2. Patients with an eGFR higher than 90 ml/min/1.73 m2 had significantly lower PRA and higher ARR levels than patients with an eGFR lower than 90 ml/min/1.73 m2 (P < 0.05). Conclusions Unsuppressed renin and lower ARR levels were associated with decreased eGFR in patients with primary aldosteronism. Diagnostic criteria of ARR by stratified eGFR may be an optimal strategy for the screening of primary aldosteronism.