Elevated plasma aldosterone concentrations relate to renal impairment in Chinese southwestern people

Evidence on the biochemical phenotypes of primary aldosteronism and renal functions is limited in Chinese. Our study aims to explore the associations of plasma aldosterone concentration (PAC), plasma renin concentration (PRC), and aldosterone-to-renin ratio (ARR) with renal functions. This cross-sectional study enrolled 1,700 participants from southwest China. A generalized linear mixed model (GLMM) was employed to analyze the associations of PAC, PRC and ARR with renal function parameters: serum creatinine (SCR), blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR), their dose-response relationships were further assessed using P-trend and restricted cubic spline (RCS) analyses. The mediating effects of blood pressure on the associations between PAC and renal function were evaluated using structural equation model (SEM). In the overall cohort, GLMM results indicated that higher 1-log PAC were associated with elevated levels of SCR (β [95% CI] = 0.451 [0.329, 0.573]) and BUN (β [95% CI] = 0.370 [0.278, 0.462]), lower eGFR (β [95% CI] = -0.263 [-0.331, -0.194]). Furthermore, RCS supported a positive linear association between PAC with SCR and BUN, but a negative linear association with eGFR. Compared with the female subgroup, a relatively stronger significant association is observed between PAC with SCR and BUN in the male subgroup. Noticeably, the use of Renin-Angiotensin-Aldosterone (RAS) inhibitors can mitigate the positive effects of PAC on BUN. Additionally, systolic blood pressure played a slightly mediated effect on association of PAC with SCR and eGFR, with the mediation proportions were 2.4% and 2.6%, respectively. Our study found a continuum spectrum of PAC is associated with renal impairment, particularly in males, and the use of RAS inhibitors can alleviate renal function impairment to a certain extent.