Higher Screening Aldosterone to Renin Ratio in Primary Aldosteronism Patients with Diabetes Mellitus

Abstract

Accumulated evidence has shown that low renin hypertension is common in patients with diabetic nephropathy. However, the performance of aldosterone to renin ratio (ARR) in primary aldosteronism (PA) patients with diabetes has not been well validated. Here, we report the performance of screening ARR in PA patients with diabetes. The study enrolled consecutive patients and they underwent ARR testing at screening. Then the diagnosis of PA was confirmed from the Taiwan Primary Aldosteronism Investigation registration dataset. Generalized additive model smoothing plot was used to validate the performance of screening ARR in PA patients with or without diabetes. During this study period, 844 PA patients were confirmed and 136 (16.0%) among them had diabetes. Other 816 patients were diagnosed with essential hypertension and used as the control group and 89 (10.9%) among them had diabetes. PA patients with diabetes were older and had a longer duration of hypertensive latency, higher systolic blood pressure and lower glomerular filtration rate than those PA patients without diabetes. The cut-off value of ARR in the generalized additive model predicting PA was 65 ng/dL per ng/mL/h in diabetic patients, while 45 ng/dL per ng/mL/h in non-diabetic patients. There was a considerable prevalence of diabetes among PA patients, which might be capable of interfering with the conventional screening test. The best cut-off value of ARR, more than 65 ng/dL per ng/mL/h in PA patients with diabetes, was higher than those without diabetes.

Higher Blood Urea Nitrogen and Urinary Calcium: New Risk Factors for Diabetes Mellitus in Primary Aldosteronism Patients

“…In addition, it was also shown in vitro that aldosterone may inhibit extra-renal tissues (such as adipocytes and skeletal muscle cells) from absorbing glucose by degrading insulin receptors via increasing proinflammatory cytokines and reactive oxygen species (21,22). However, some recent studies did not find any evidence to support that higher PAC may have adverse effect on glucose metabolism (9,13,14). Interestingly, our study found that PA + DM patients had lower PAC (lying position) when compared with PA patients.…”

“…And it was confirmed by some studies which showed lower serum potassium concentration in PA patients with DM (11,12). However, some studies also showed that low serum potassium may not contribute to the development of DM (9,10,13). At present, the underlying contributors to DM in PA patients were still not quite clear.…”

“…Some scientists regarded high serum aldosterone as a risk factor for DM (10)(11)(12). However, others did not find any association between PAC and DM (9,13,14). Additionally, Watanabe et al reported a negative correlation between serum potassium and insulin sensitivity (15).…”

Prevalence, diagnosis and outcomes of treatment for primary aldosteronism

“…Käyser et al [33] systematically reviewed 39 studies comprising 42510 patients with 36614 patients from hypertension units (26 studies) and 5896 patients from primary care 13 studies) and reported a prevalence of PA in hypertension referral centres ranging from 0.7% to 29.8% and from 3.2% to 12.7% in primary care. An additional 9 studies on the prevalence of PA in referred patients have since been published [33,[46][47][48][49][50][51][52][53][54], bringing the median prevalence of PA in 55045 referred patients with hypertension in all 36 studies to date to 7.0%.…”

High Efficiency and Problems of Chemiluminescence Assay-Detected Aldosterone-To-Renin Ratio in Practical Primary Aldosteronism Screening

“…Diabetes is reported to raise the cutoff value of radioimmunoassay detected ARR for PA screening [ 17 ]. Then, we assessed the influence of diabetes on screening efficiency in our study.…”