Plasma renin activity and the aldosterone-to-renin ratio are associated with the development of chronic kidney disease: The Ohasama Study

Shiho Terata, Masahiro Kikuya, Michihiro Satoh, Takayoshi Ohkubo, Takanao Hashimoto, Azusa Hara, Takuo Hirose, Taku Obara, Hirohito Metoki, Ryusuke Inoue, Kei Asayama, Atsuhiro Kanno, Kazuhito Totsune, Haruhisa Hoshi, Hiroshi Satoh, Hiroshi Sato, Yutaka Imai

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Abstract

Background: The aldosterone-to-renin ratio (ARR) is used to screen for primary aldosteronism and could be an index for salt sensitivity. The association between ARR and the development of chronic kidney disease (CKD) is completely unknown. Method: A longitudinal observational study involving 689 participants from a general Japanese population (mean age 58.2 years; 68.5% women) who did not have CKD and were not receiving antihypertensive medication at baseline was conducted. The estimated glomerular filtration rate (eGFR) was calculated from serum creatinine levels, and CKD was defined as eGFR less than 60ml/min per 1.73m2 and/or dipstick-positive proteinuria. The associations of baseline plasma renin activity (PRA), plasma aldosterone concentration, and ARR with the development of CKD were examined using Cox proportional hazard regression analysis adjusted for sex, age, BMI, smoking, drinking, history of hypercholesterolemia, diabetes mellitus, and cardiovascular disease, SBP, and baseline eGFR. Results: During a mean 9.1-year follow-up, 118 participants developed CKD. A 1 standard deviation increment in the natural log-transformed (ln) ARR was positively associated with the incidence of CKD (hazard ratio 1.29, P=0.012). LnPRA showed an inverse association (hazard ratio 0.76, P=0.007). Meanwhile, plasma aldosterone concentration was not associated with CKD. Individuals who developed CKD had significantly lower baseline PRA (0.97 vs. 1.14ng/ml per h; P=0.03) and higher baseline ARR levels [66.6 vs. 56.8 (pg/ml)/(ng/ml per h); P=0.02] than those who did not. Conclusions: Lower PRA and higher ARR were associated with the development of CKD in a general population, suggesting that they are independent predictors of CKD.

Original languageEnglish
Pages (from-to)1632-1638
Number of pages7
JournalJournal of hypertension
Volume30
Issue number8
DOIs
Publication statusPublished - 2012 Aug 1
Externally publishedYes

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Keywords

  • aldosterone excess
  • aldosterone-to-renin ratio
  • chronic kidney disease
  • general population
  • prospective cohort study

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Terata, S., Kikuya, M., Satoh, M., Ohkubo, T., Hashimoto, T., Hara, A., Hirose, T., Obara, T., Metoki, H., Inoue, R., Asayama, K., Kanno, A., Totsune, K., Hoshi, H., Satoh, H., Sato, H., & Imai, Y. (2012). Plasma renin activity and the aldosterone-to-renin ratio are associated with the development of chronic kidney disease: The Ohasama Study. Journal of hypertension, 30(8), 1632-1638. https://doi.org/10.1097/HJH.0b013e328354f65b